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Endocardial biventricular pacing for chronic heart failure patients: Effect on transmural dispersion of

Muhammad Yamin1, Yoga Yuniadi2, Idrus Alwi1

  • 1Department of Internal Medicine, Faculty of Medicine Universitas Indonesia - Cipto Mangunkusumo Hospital Jakarta Indonesia.

Journal of Arrhythmia
|August 15, 2019
PubMed

Insights

Endocardial biventricular pacing can reduce fatal arrhythmia by decreasing transmural dispersion of repolarization (TDR). Pacing at the right ventricular apex and left ventricular lateral/posterolateral walls achieved the most homogenous TDR, suggesting improved safety for cardiac resynchronization therapy.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Conventional epicardial cardiac resynchronization therapy (CRT) is linked to fatal arrhythmias due to increased transmural dispersion of repolarization (TDR).
  • The impact of endocardial biventricular pacing locations on TDR and subsequent arrhythmia risk remains unclear.

Purpose of the Study:

  • To determine the optimal endocardial biventricular pacing location for minimizing TDR.
  • To identify pacing strategies that reduce the risk of fatal arrhythmias in chronic heart failure (CHF) patients.

Main Methods:

  • A before-and-after study design was employed in adult CHF patients undergoing endocardial biventricular pacing.
  • Transmural dispersion of repolarization (TDR) was measured and compared across various pacing locations.
  • Statistical analysis assessed the homogeneity of TDR at different pacing sites.

Main Results:

  • The highest TDR was observed with right ventricular outlet septum and left ventricular lateral wall pacing (RVOTseptum-LVlateral).
  • The lowest TDR was achieved with right ventricular apex and left ventricular posterolateral wall pacing (RVapex-LVposterolateral).
  • Pacing at the right ventricular apex combined with the left ventricular lateral or posterolateral walls demonstrated the most homogenous TDR.

Conclusions:

  • Endocardial biventricular pacing at the right ventricular apex and left ventricular lateral/posterolateral walls effectively homogenizes TDR.
  • These pacing locations hold promise for reducing fatal arrhythmias associated with CRT in heart failure patients.
Abstract

Keywords:
arrhythmiacardiac resynchronization therapychronic heart failureendocardial biventricular pacingtransmural dispersion of repolarization

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