Multipoint pacing controlled the electrical storm induced by cardiac resynchronization therapy
Makaleler > Tam Makale · 2018
Yazarlar: Emin Evren Özcan, Yiğit Yılancıoğlu, Can HASDEMİR
EP Europace, Uluslararası, Wos, 2018, cilt 20, ss 1749-1749
Özet
A 42-year-old man with the diagnosis of non-ischaemic cardiomyopathy suffered an anti-arrhythmic drug-resistant electrical storm (ES) due to recurrent polymorphic ventricular tachycardia (PMVT) episodes, within several hours of initiation of cardiac resynchronization therapy (CRT). Since the quadripolar left ventricular (LV) lead was implanted, different LV pacing sites and polarities were programmed to overcome pacing site-dependent proarrhythmic effects. However, every attempt triggered PMVTs. Finally, multipoint LV pacing was programmed to create a larger depolarization wavefront. Immediately after this adjustment ventricular arrhythmias were suppressed. Reversal of normal myocardial activation sequence during epicardial pacing, as it occurs during CRT may increase transmural dispersion of repolarization and QT interval which may lead to PMVTs. Multipoint LV pacing resulted in suppression of ES. Immediately after programming, QT interval was decreased from 490 to 460 ms within seconds, without other modifications of device settings. Although each attempt from different LV pacing sites failed, but multipoint pacing was effective. Larger depolarization wavefront initiated by multipoint LV pacing may result in more homogeneous repolarization pattern and may suppress the PMVTs. Same mechanism may also be effective to control scar-related monomorphic ventricular tachycardias. This case highlights for the first time the potential role of multipoint LV pacing for emergency treatment of ES induced by CRT. The full-length version of this report can be viewed at: https://www.escardio.org/Education/E-Learning/Clinical-cases/Electrophysiology.