Optimization of repolarization during biventricular pacing: a new target in patients with biventricular devices?
BACKGROUND
Evaluation of repolarization during sequentional biventricular pacing.


METHODS
Patients with biventricular devices, and left ventricular leads placed to the basal part of lateral left ventricular wall were enrolled. QRS, QTc, JTc, and corrected Tpeak-Tend intervals were compared during sequentional biventricular, left ventricular, and right ventricular pacing.


RESULTS
Five patients with nonischemic and five with ischemic cardiomyopathy due to anterior myocardial infarction were enrolled. No correlation was observed between values of repolarization among patients. The optimal values of repolarization were significantly different from values of echocardiographically guided hemodynamic optimization. Two patients with biventricular pacing-induced ventricular fibrillation were successfully treated by reprogramming of V-V delay according to interventricular delay resulting in shorter Tpeak-Tend interval, although delayed effect of amiodarone in one of these patients cannot be ruled out.


CONCLUSIONS
Patients with biventricular devices may be prone to development of ventricular arrhythmias depending on programmed V-V interval. We suggest that optimization of repolarization may be performed in patients with biventricular pacemakers in the absence of backup ICD and those with frequent episodes of ventricular tachyarrhythmias, although this finding deserves further study.
Istanbul University, Institute of Cardiology, Department of Cardiology, Division of Pacing and Electrophysiology, Istanbul, Turkey.
Cengizhan
C
Türkoğlu
Farid
F
Aliyev
Cengiz
C
Celiker
Gökhan
G
Cetin
Gökhan
G
Alici
Işil
I
Uzunhasan
Inci
I
Firatli
D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000209:etiology*; D002311:Cardiomyopathy, Dilated / Q000628:therapy; D004562:Electrocardiography / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D017202:Myocardial Ischemia / Q000628:therapy; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D012815:Signal Processing, Computer-Assisted; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000209:etiology