Optimization of Repolarization during Biventricular Pacing: A New Target in Patients with Biventricular Devices?

Authors

  • Cengizhan Türkoğlu M.D.,

    1. Istanbul University, Institute of Cardiology, Department of Cardiology, Division of Pacing and Electrophysiology, Istanbul, Turkey
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  • Farid Aliyev M.D.,

    1. Istanbul University, Institute of Cardiology, Department of Cardiology, Division of Pacing and Electrophysiology, Istanbul, Turkey
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  • Cengiz Çeliker M.D.,

    1. Istanbul University, Institute of Cardiology, Department of Cardiology, Division of Pacing and Electrophysiology, Istanbul, Turkey
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  • Gökhan Çetin M.D.,

    1. Istanbul University, Institute of Cardiology, Department of Cardiology, Division of Pacing and Electrophysiology, Istanbul, Turkey
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  • Gökhan Alici M.D.,

    1. Istanbul University, Institute of Cardiology, Department of Cardiology, Division of Pacing and Electrophysiology, Istanbul, Turkey
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  • Işil Uzunhasan M.D.,

    1. Istanbul University, Institute of Cardiology, Department of Cardiology, Division of Pacing and Electrophysiology, Istanbul, Turkey
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  • Inci Firatli M.D.

    1. Istanbul University, Institute of Cardiology, Department of Cardiology, Division of Pacing and Electrophysiology, Istanbul, Turkey
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  • Financial support: None.

Address for correspondence: Farid Aliyev, M.D., Istanbul University, Institute of Cardiology, Department of Cardiology, Division of Pacing and Electrophysiology, Haseki-Fatih, 34034, Istanbul, Turkey. Fax: + 90 212 570 40 98; E-mail: drfaridaliyev@yahoo.com.tr

Abstract

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.

Ann Noninvasive Electrocardiol 2010;15(1):36–42

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