Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz

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SHR Neuro Krebs Kardio Lipid

Costa, CM; Neic, A; Kerfoot, E; Porter, B; Sieniewicz, B; Gould, J; Sidhu, B; Chen, Z; Plank, G; Rinaldi, CA; Bishop, MJ; Niederer, SA.
Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis.
Heart Rhythm. 2019; [OPEN ACCESS]
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Autor/innen der Med Uni Graz:
Neic Aurel-Vasile
Plank Gernot
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Abstract:
Cardiac resynchronization therapy (CRT) increases the risk of ventricular tachycardia (VT) in patients with ischemic cardiomyopathy (ICM) when the left ventricular (LV) epicardial lead is implanted in proximity to scar. To determine the mechanisms underpinning this risk, we investigate the effects of pacing on local electrophysiology (EP) in relation to scar that provides a substrate for VT in ICM patients undergoing CRT. Imaging data from ICM patients (n=24) undergoing CRT were used to create patient-specific LV anatomical computational models including scar morphology. Simulations of LV epicardial pacing at 0.2-4.5cm from the scar were performed using EP models of chronic infarct and heart failure (HF). Dispersion of repolarization and the vulnerable window were computed, as surrogates of VT risk. Simulations predict that pacing in proximity to scar (0.2cm) compared to more distant pacing to a scar (4.5cm) significantly (P<0.01) increased dispersion of repolarization in the vicinity of the scar and widened (P<0.01) the vulnerable window increasing the likelihood of uni-directional block. Moreover, slow conduction during HF further increased dispersion (∼194%). ANOVA and post hoc tests show significantly (P<0.01) reduced repolarization dispersion when pacing 3.5cm or more from the scar compared to pacing at 0.2cm. Increased dispersion of repolarization in the vicinity of the scar and widening of the vulnerable window when pacing in proximity to scar provides a mechanistic explanation for VT induction in ICM-CRT with lead placement proximal to scar. Pacing 3.5cm from scar may avoid increasing VT risk in ICM-CRT patients. Copyright © 2019. Published by Elsevier Inc.

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