TY - JOUR
T1 - Short-spaced dipole for managing phrenic nerve stimulation in patients with CRT
T2 - The phrenic nerve mapping and stimulation EP catheter study
AU - Biffi, Mauro
AU - Zanon, Francesco
AU - Bertaglia, Emanuele
AU - Padeletti, Luigi
AU - Varbaro, Annamaria
AU - De Santo, Tiziana
AU - Boriani, Giuseppe
AU - Yang, Zhongping
PY - 2013/1
Y1 - 2013/1
N2 - Background: Phrenic nerve stimulation (PNS), occurring in 33%-37% of the patients with cardiac resynchronization therapy (CRT), is a limiting factor when implanting left ventricular (LV) leads from coronary veins. Objective: To test the hypothesis that PNS occurence is related to bipolar electrode spacing. Methods: During standard CRT defibrillator implant procedures, a 5-F diagnostic electrophysiology catheter with 10 electrodes, spaced 2-5-2 mm, was positioned in a cardiac vein suitable for permanent LV lead placement. Pacing in the unipolar configuration identified the site with the lowest PNS threshold. PNS and left ventricular pacing (LVP) thresholds were then measured in different configurations at 0.5 ms: unipolar, each LV electrode served as the cathode in turn; and bipolar with different electrode spacing, cathode being the electrode with the lowest unipolar PNS threshold. Results: From February to September 2010, 40 patients undergoing CRT implantation were enrolled in 4 centers in Italy. It was possible to identify PNS and perform a complete set of measurements in 23 patients. A bipolar electrode spacing of 2 mm resulted in higher PNS thresholds in bipolar configurations han did a bipolar electrode spacing of≥5 mm. However, no significant increase in the LVP threshold was observed (P = ns). Conclusions: This experience suggests that LVP with a bipolar electrode spacing of 2 mm significantly increases the PNS threshold without affecting the LVP threshold, thereby increasing the possibility of delivering CRT when the LV lead is placed in proximity to the phrenic nerve.
AB - Background: Phrenic nerve stimulation (PNS), occurring in 33%-37% of the patients with cardiac resynchronization therapy (CRT), is a limiting factor when implanting left ventricular (LV) leads from coronary veins. Objective: To test the hypothesis that PNS occurence is related to bipolar electrode spacing. Methods: During standard CRT defibrillator implant procedures, a 5-F diagnostic electrophysiology catheter with 10 electrodes, spaced 2-5-2 mm, was positioned in a cardiac vein suitable for permanent LV lead placement. Pacing in the unipolar configuration identified the site with the lowest PNS threshold. PNS and left ventricular pacing (LVP) thresholds were then measured in different configurations at 0.5 ms: unipolar, each LV electrode served as the cathode in turn; and bipolar with different electrode spacing, cathode being the electrode with the lowest unipolar PNS threshold. Results: From February to September 2010, 40 patients undergoing CRT implantation were enrolled in 4 centers in Italy. It was possible to identify PNS and perform a complete set of measurements in 23 patients. A bipolar electrode spacing of 2 mm resulted in higher PNS thresholds in bipolar configurations han did a bipolar electrode spacing of≥5 mm. However, no significant increase in the LVP threshold was observed (P = ns). Conclusions: This experience suggests that LVP with a bipolar electrode spacing of 2 mm significantly increases the PNS threshold without affecting the LVP threshold, thereby increasing the possibility of delivering CRT when the LV lead is placed in proximity to the phrenic nerve.
KW - Bipolar electrode spacing
KW - Cardiac resynchronization therapy
KW - Phrenic nerve stimulation
KW - Threshold
UR - http://www.scopus.com/inward/record.url?scp=84872011156&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84872011156&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2012.08.045
DO - 10.1016/j.hrthm.2012.08.045
M3 - Article
C2 - 23063865
AN - SCOPUS:84872011156
VL - 10
SP - 39
EP - 45
JO - Heart Rhythm
JF - Heart Rhythm
SN - 1547-5271
IS - 1
ER -