Therapy is determined by pacing on epicardial scar and can be successfully managed by catheter ablation

  • Roque C
  • Trevisi N
  • Silberbauer J
 et al. 
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BACKGROUND: The mechanism of cardiac resynchronization therapy (CRT)-induced proarrhythmia remains unknown. We postulated that pacing from a left ventricular (LV) lead positioned on epicardial scar can facilitate re-entrant ventricular tachycardia. The aim of this study was to investigate the relationship between CRT-induced proarrhythmia and LV lead location within scar. METHODS AND RESULTS: Twenty-eight epicardial and 63 endocardial maps, obtained from 64 CRT patients undergoing ventricular tachycardia ablation, were analyzed. A positive LV lead/scar relationship, defined as a lead tip positioned on scar/border zone, was determined by overlaying fluoroscopic projections with LV electroanatomical maps. CRT-induced proarrhythmia occurred in 8 patients (12.5%). They all presented early with electrical storm (100% versus 39% of patients with no proarrhythmia; P

Author-supplied keywords

  • Cardiac resynchronization therapy
  • Catheter ablation
  • Tachycardia, ventricular

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  • Carla Roque

  • Nicola Trevisi

  • John Silberbauer

  • Teresa Oloriz

  • Hiroya Mizuno

  • Francesca Baratto

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