Management of Phrenic Stimulation in CRT Patients over the Long Term: Still an Unmet Need ?
- 8 June 2011
- journal article
- Published by Wiley in Pacing and Clinical Electrophysiology
- Vol. 34 (10), 1201-1208
- https://doi.org/10.1111/j.1540-8159.2011.03147.x
Abstract
Background: Phrenic stimulation (PS) may cause intolerable symptoms and prevent CRT delivery in 2–5% of patients. We sought to ensure effective cardiac resynchronization therapy (CRT) delivery by management of PS at the left ventricular (LV) target site. Methods and Results : Two hundred and eleven consecutive patients received a CRT device despite PS occurrence at the LV target site at implantation, when a PS-LV difference >2V was achieved by LV stimulation programming (cathode, pacing vector). PS management strategy both at implantation and at follow-up (FU) aimed to keep the target LV implantation site. LV reverse remodeling was assessed by echocardiography before implantation and at follow-up. LV lead placement was lateral/posterolateral in all the 211 patients; 51 of 211 had detectable PS at FU, 26 of 211 (12.3%) were symptomatic. Symptoms occurred more frequently when PS-LV difference was Conclusions : CRT delivery at long term is feasible despite PS at the target LV site. PS management is mandatory in about 12.3% of patients at FU, with 6.6% remaining symptomatic. Symptoms improve at FU when a PS-LV >3V is achieved. Further improvement in lead manufacturing and pacing electronics are awaited to meet this clinical need. (PACE 2011; 34:1201–1208)Keywords
This publication has 24 references indexed in Scilit:
- Phrenic stimulation management in CRT patients: are we there yet?Current Opinion in Cardiology, 2011
- Improved success rate of cardiac resynchronization therapy implant by employing an active fixation coronary sinus leadEP Europace, 2010
- Fluctuation of left ventricular thresholds and required safety margin for left ventricular pacing with cardiac resynchronization therapyEP Europace, 2009
- Automatic Management of Left Ventricular Stimulation: Hints for Technologic ImprovementPacing and Clinical Electrophysiology, 2009
- Exercise stress echocardiography is superior to rest echocardiography in predicting left ventricular reverse remodelling and functional improvement after cardiac resynchronization therapyEuropean Heart Journal, 2008
- Impact of left ventricular lead position on the efficacy of cardiac resynchronisation therapy: a two-dimensional strain echocardiography studyPublished by BMJ ,2007
- Single-centre experience with coronary sinus lead stability and long-term pacing parametersEP Europace, 2007
- Programmable Multiple Pacing Configurations Help to Overcome High Left Ventricular Pacing Thresholds and Avoid Phrenic Nerve StimulationPacing and Clinical Electrophysiology, 2005
- Clinical Performance of a Ventricular Automatic Capture Verification AlgorithmPacing and Clinical Electrophysiology, 2005
- Differences in Tachyarrhythmia Detection and Implantable Cardioverter Defibrillator Therapy by Primary or Secondary Prevention Indication in Cardiac Resynchronization Therapy PatientsJournal of Cardiovascular Electrophysiology, 2004