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Transseptal left ventricular endocardial pacing reduces dispersion of ventricular repolarization

Scott, Paul A., Yue, Arthur M., Watts, Edd, Zeb, Mehmood, Roberts, Paul R. and Morgan, John M. (2011) Transseptal left ventricular endocardial pacing reduces dispersion of ventricular repolarization PACE Pacing and Clinical Electrophysiology, 34, (10), pp. 1258-1266. (doi:10.1111/j.1540-8159.2011.03138.x). (PMID:21615758).

Record type: Article


Background: ?Cardiac resynchronization therapy (CRT) may be proarrhythmic in some patients. This may be due to the effect of left ventricular (LV) epicardial pacing on ventricular repolarization. The purpose of this study was to evaluate the effect of endocardial versus epicardial LV biventricular pacing on surface electrocardiogram (ECG) parameters that are known markers of arrhythmogenic repolarization.

Methods: ?ECG markers of repolarization (QT dispersion, QTD; T peak to end, T(peak-end) ; T(peak-end) dispersion, T(peak-end) D; QTc) were retrospectively measured before and after CRT in seven patients with transseptal LV endocardial leads (TS group), 28 matched patients with coronary sinus (CS) LV leads (CS group), and eight patients with surgical LV epicardial leads (SUR group). All ECGs were scanned and analyzed using digital callipers.

Results: ?Compared to the CS group, the TS group CRT was associated with a significant postpacing reduction in QTD (-45.2 ± 35.6 vs -4.3 ± 43.6 ms, P = 0.03) and T(peak-end) (-24.2 ± 22.1 vs 3.4 ± 26.7 ms, P = 0.02). There was a nonsignificant post-CRT reduction in both T(peak-end) D (-11.3 ± 31.0 vs 2.4 ± 28.9 ms, P = 0.27) and QTc (-50.0 ± 46.4 vs 4.4 ± 70.2 ms, P = 0.06) in the TS versus the CS group. In contrast, there were no differences between the SUR and CS groups in terms of the effect of CRT on these repolarization parameters.

Conclusions: ?CRT with (atrial transseptal) endocardial LV lead placement is associated with repolarization characteristics that are considered to be less arrhythmogenic than those generated by CS (epicardial) LV lead placement. Further work is needed to determine whether these changes translate to a reduction in proarrhythmia.

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e-pub ahead of print date: 26 May 2011
Published date: October 2011
Organisations: Human Development & Health


Local EPrints ID: 338786
PURE UUID: 75694221-7f0e-4106-b91b-8e2c9ac492d2

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Date deposited: 17 May 2012 10:12
Last modified: 18 Jul 2017 05:57

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Author: Paul A. Scott
Author: Arthur M. Yue
Author: Edd Watts
Author: Mehmood Zeb
Author: Paul R. Roberts
Author: John M. Morgan

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