Feasibility of cathodic-anodal left ventricular stimulation for alternative multisite pacing

Pacing Clin Electrophysiol. 2018 Jun;41(6):597-602. doi: 10.1111/pace.13344. Epub 2018 Apr 30.

Abstract

Background: Simultaneous cathodic-anodal capture by a bipole of a cardiac resynchronization therapy (CRT) left-ventricular (LV) catheter may depolarize a larger LV area than conventional multipoint pacing. We evaluated the feasibility of cathodic-anodal LV stimulation.

Methods: In 30 patients undergoing CRT with a quadripolar LV lead, we evaluated the cathodic and anodal capture threshold for each LV pole and compared QRS on electrocardiogram (ECG) during single-point cathodic biventricular stimulation (S-BS), multipoint BS (M-BS), and cathodic-anodal BS (CA-BS).

Results: Anodal capture was obtained by three poles in 23/30 patients, by two poles in five, and was not feasible in two. The mean single-point anodal threshold was 3.93 V versus single-point cathodic threshold of 1.95 V. On comparing ECGs, M-BS and CA-BS produced similar QRS wavefront activation in 90% of patients.

Conclusions: CA-BS is feasible and may be used in LV pacing to achieve a different wavefront of electrical activation. Further prospective studies are needed in order to verify the clinical impact of this kind of stimulation.

Keywords: anodal stimulation; multisite pacing; resynchronization therapy; surface ECG.

MeSH terms

  • Aged
  • Bundle-Branch Block / physiopathology*
  • Bundle-Branch Block / therapy*
  • Cardiac Resynchronization Therapy / methods*
  • Cardiac Resynchronization Therapy Devices*
  • Electrocardiography
  • Feasibility Studies
  • Female
  • Heart Failure / physiopathology*
  • Heart Failure / therapy*
  • Heart Ventricles / physiopathology*
  • Humans
  • Male
  • Treatment Outcome