King's College London

Research portal

Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis.

Research output: Contribution to journalArticlepeer-review

Standard

Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis. / Mendonca Costa, Caroline; Neic, Aurel; Kerfoot, Eric et al.

In: Heart Rhythm, Vol. 16, No. 10, 10.2019, p. 1475-1483.

Research output: Contribution to journalArticlepeer-review

Harvard

Mendonca Costa, C, Neic, A, Kerfoot, E, Porter, B, Sieniewicz, B, Gould, J, Sidhu, B, Chen, Z, Plank, G, Rinaldi, CA, Bishop, MJ & Niederer, SA 2019, 'Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis.', Heart Rhythm, vol. 16, no. 10, pp. 1475-1483. https://doi.org/10.1016/j.hrthm.2019.03.027

APA

Mendonca Costa, C., Neic, A., Kerfoot, E., Porter, B., Sieniewicz, B., Gould, J., Sidhu, B., Chen, Z., Plank, G., Rinaldi, C. A., Bishop, M. J., & Niederer, S. A. (2019). Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis. Heart Rhythm, 16(10), 1475-1483. https://doi.org/10.1016/j.hrthm.2019.03.027

Vancouver

Mendonca Costa C, Neic A, Kerfoot E, Porter B, Sieniewicz B, Gould J et al. Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis. Heart Rhythm. 2019 Oct;16(10):1475-1483. https://doi.org/10.1016/j.hrthm.2019.03.027

Author

Mendonca Costa, Caroline ; Neic, Aurel ; Kerfoot, Eric et al. / Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis. In: Heart Rhythm. 2019 ; Vol. 16, No. 10. pp. 1475-1483.

Bibtex Download

@article{7539bc5c743b45659d14c718d894e45c,
title = "Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis.",
abstract = "BackgroundCardiac 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.ObjectiveThe purpose of this study was to determine the mechanisms underpinning this risk by investigating the effects of pacing on local electrophysiology (EP) in relation to scar that provides a substrate for VT in ICM patients undergoing CRT.MethodsImaging data from ICM patients (n = 24) undergoing CRT were used to create patient-specific LV anatomic computational models including scar morphology. Simulations of LV epicardial pacing at 0.2–4.5 cm 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 for VT risk.ResultsSimulations predict that pacing in proximity to scar (0.2 cm) compared to more distant pacing to a scar (4.5 cm) significantly (P <.01) increased dispersion of repolarization in the vicinity of the scar and widened (P <.01) the vulnerable window, increasing the likelihood of unidirectional block. Moreover, slow conduction during HF further increased dispersion (∼194%). Analysis of variance and post hoc tests show significantly (P <.01) reduced repolarization dispersion when pacing ≥3.5 cm from the scar compared to pacing at 0.2 cm.ConclusionIncreased 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 3.5 cm or more from scar may avoid increasing VT risk in ICM-CRT patients.",
keywords = "Cardiac resynchronization therapy, Infarct scar, Patient-specific modeling, Ventricular tachycardia",
author = "{Mendonca Costa}, Caroline and Aurel Neic and Eric Kerfoot and Bradley Porter and Benjamin Sieniewicz and Justin Gould and Baldeep Sidhu and Zhong Chen and Gernot Plank and Rinaldi, {Christopher A.} and Bishop, {Martin J.} and Niederer, {Steven A.}",
note = "The data supporting this study is openly available at http://doi.org/10.18742/RDM01-570",
year = "2019",
month = oct,
doi = "10.1016/j.hrthm.2019.03.027",
language = "English",
volume = "16",
pages = "1475--1483",
journal = "Heart Rhythm",
issn = "1547-5271",
publisher = "Elsevier",
number = "10",

}

RIS (suitable for import to EndNote) Download

TY - JOUR

T1 - Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis.

AU - Mendonca Costa, Caroline

AU - Neic, Aurel

AU - Kerfoot, Eric

AU - Porter, Bradley

AU - Sieniewicz, Benjamin

AU - Gould, Justin

AU - Sidhu, Baldeep

AU - Chen, Zhong

AU - Plank, Gernot

AU - Rinaldi, Christopher A.

AU - Bishop, Martin J.

AU - Niederer, Steven A.

N1 - The data supporting this study is openly available at http://doi.org/10.18742/RDM01-570

PY - 2019/10

Y1 - 2019/10

N2 - BackgroundCardiac 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.ObjectiveThe purpose of this study was to determine the mechanisms underpinning this risk by investigating the effects of pacing on local electrophysiology (EP) in relation to scar that provides a substrate for VT in ICM patients undergoing CRT.MethodsImaging data from ICM patients (n = 24) undergoing CRT were used to create patient-specific LV anatomic computational models including scar morphology. Simulations of LV epicardial pacing at 0.2–4.5 cm 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 for VT risk.ResultsSimulations predict that pacing in proximity to scar (0.2 cm) compared to more distant pacing to a scar (4.5 cm) significantly (P <.01) increased dispersion of repolarization in the vicinity of the scar and widened (P <.01) the vulnerable window, increasing the likelihood of unidirectional block. Moreover, slow conduction during HF further increased dispersion (∼194%). Analysis of variance and post hoc tests show significantly (P <.01) reduced repolarization dispersion when pacing ≥3.5 cm from the scar compared to pacing at 0.2 cm.ConclusionIncreased 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 3.5 cm or more from scar may avoid increasing VT risk in ICM-CRT patients.

AB - BackgroundCardiac 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.ObjectiveThe purpose of this study was to determine the mechanisms underpinning this risk by investigating the effects of pacing on local electrophysiology (EP) in relation to scar that provides a substrate for VT in ICM patients undergoing CRT.MethodsImaging data from ICM patients (n = 24) undergoing CRT were used to create patient-specific LV anatomic computational models including scar morphology. Simulations of LV epicardial pacing at 0.2–4.5 cm 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 for VT risk.ResultsSimulations predict that pacing in proximity to scar (0.2 cm) compared to more distant pacing to a scar (4.5 cm) significantly (P <.01) increased dispersion of repolarization in the vicinity of the scar and widened (P <.01) the vulnerable window, increasing the likelihood of unidirectional block. Moreover, slow conduction during HF further increased dispersion (∼194%). Analysis of variance and post hoc tests show significantly (P <.01) reduced repolarization dispersion when pacing ≥3.5 cm from the scar compared to pacing at 0.2 cm.ConclusionIncreased 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 3.5 cm or more from scar may avoid increasing VT risk in ICM-CRT patients.

KW - Cardiac resynchronization therapy

KW - Infarct scar

KW - Patient-specific modeling

KW - Ventricular tachycardia

UR - http://www.scopus.com/inward/record.url?scp=85072259621&partnerID=8YFLogxK

U2 - 10.1016/j.hrthm.2019.03.027

DO - 10.1016/j.hrthm.2019.03.027

M3 - Article

VL - 16

SP - 1475

EP - 1483

JO - Heart Rhythm

JF - Heart Rhythm

SN - 1547-5271

IS - 10

ER -

View graph of relations

© 2020 King's College London | Strand | London WC2R 2LS | England | United Kingdom | Tel +44 (0)20 7836 5454