Author + information
- Justo Julia Calvo,
- Maria Lopez-Gil,
- Adolfo Fontenla,
- Lola Villagraz Tecedor,
- Alvaro Lozano Rosado,
- Rafael Salguero Bodes and
- Fernando Arribas
Background: Phrenic stimulation (PS) after implant of a left ventricle (LV) lead occurs in 3 to 25% of patients. Changes in the anatomical relationship between left phrenic nerve and coronary veins due to the reverse remodeling observed in super responders (SR) might be the underlying mechanism in patients developing late onset PS without evidence of lead dislodgement (LD).
Methods: Consecutive patients implanted with a LV lead in our center were retrospectively analyzed. Patients lost in follow up or with epicardial leads were excluded. PS was classified as “early” if occurred within 3 months from implantation and “late” if developed afterwards. “Late” PS was considered related to LD (LD PS) when LV threshold differed >1V or impedance >250 Ohm from baseline values or in case of radiological displacement. Cases not meeting the former were classified as “non LD PS”. SR was defined as a decrease ≥30% of the LV end systolic volume at 1 year.
Results: At 12 ± 10 months follow up PS occurred in 20 of 139 patients. Late non LD PS incidence was significantly higher among SR (13.1% vs 1.3%; p= 0.010) and remained the only predictor of non LD PS at multivariate analysis. Figure 1 shows the incidence of PS in each group and compares the distance from LV lead to cardiac border in chest x-ray at implantation (A) and 9 months after (B) in a SR.
Conclusions: Late non LD PS is more frequent in SR to resynchronization therapy, suggesting a potential role for the modification of the anatomical relationship between left phrenic nerve and coronary veins.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Arrhythmias and Clinical EP: Devices 1
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1109-087
- 2017 American College of Cardiology Foundation