Abstract
Purpose
There are not enough data about threshold changes in patients with CRT. In this study, we aimed to investigate frequency of significant threshold increase of left ventricle lead and to determine clinical, demographic, medical and laboratory parameters that associated with threshold increase in CRT implanted patients.
Methods
We included CRT implanted 200 patients (124 males, 76 females; mean age 65.8 ± 10.3 years) to this study. Basal and third month LV R wave amplitude, electrode impedance, and threshold values were recorded. Threshold increase was accepted as ≥0.1 V and significant increase as >1 V. Patients were divided into two groups: increased threshold and non-increased threshold for LV lead.
Results
Number of patients with increased LV threshold was 68 (37.6 %). Furthermore, 8 % of patients had severe increase (≥1 V) in LV threshold. We observed that serum levels of hs-CRP and 1,25 (OH)2 vitamin D were independently associated with increased LV threshold. We showed that 1 mg/dl increase in hs-CRP and the 1 mg/dl decrease in vitamin D are associated with 25.3 and 4.5 % increase in the odds of increased LV threshold, respectively.
Conclusions
Increased hs-CRP and decreased 1,25 (OH)2 vitamin D are the strongest predictors of increased LV lead thresholds. We suggest that hs-CRP and 1,25 (OH)2 vitamin D may be used as markers to predict and follow the patients with increased thresholds. It may be useful to finalize CRT procedure with more appropriate basal threshold in patients with high serum hs-CRP and low 1,25 (OH)2 vitamin D levels.
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References
McMurray JJ et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2012;14(8):803–69.
Ribeiro AL, Rincon LG, Oliveira BG, Mota CC, Pires MT. Enhancing longevity of pacemakers through reprogramming. Underutilization and cost-effectiveness. Arg Bras Cardiol. 2001;76:437–44.
Stokes KB, Kay GN. Artificial electric cardiac pacing. In: Ellenbogen KA, Kay GN, Wilkoff BL, editors. Clinical Cardiac Pacing. Philadelphia: WB Saunders; 1995. p. 1–37.
Trohman RG, Kim MH, Pinski SL. Cardiac pacing: the state of the art. Lancet. 2004;364:1701–19.
Berger T, Roıthınger FX, Antretter H, Hangler H, Pachınger O, Hıntrınger F. The influence of high versus normal impedance ventricular leads on pacemaker generator longevity. Pacing Clin Electrophysiol. 2003;26(11):2116–20.
Sahn DJ, De Maria A, Kisslo J, Weyman A. For The Committee on M-Mode Standardization of the American Society of Echocardiography, Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. Circulation. 1978;58:1072–83.
Smith TW, Chen J, Epstein LM. Implantable devices for the treatment of cardiac arrhythmia. Grossman 6th edition, Section VI: Special Catheter Techniques, vol. 22. 2000. p. 1–29.
Biffi M, Bertini M, Mazzotti A, Gardini B, Mantovani V, Ziacchi M, et al. Long-term RV threshold behavior by automated measurements: safety is the standpoint of pacemaker longevity! PACE. 2011;34:89–95.
Wild DM, Fisher JD, Kim SG, Ferrick KJ, Gross JN, Palma EC. Pacemakers and implantable cardioverter defibrillators: device longevity is more important than smaller size: the patient’s viewpoint. Pacing Clin Electrophysiol. 2004;27:1526–9.
Burri H, Gerritse B, Davenport L, Demas M, Sticherling C, Concerto AT. Clinical Study Investigators. Fluctuation of left ventricular thresholds and required safety margin for left ventricular pacing with cardiac resynchronization therapy. Europace. 2009;11:931–6.
Steinhaus DA, Waks JW, Collins R, Kleckner K, Kramer DB, Zimetbaum PJ. Effect of smaller left ventricular capture threshold safety margins to improve device longevity in recipients of cardiac resynchronization-defibrillation therapy. Am J Cardiol. 2015;116(1):85–7.
Pires LA, McNitt S, Solomon S, Goldenberg I, Zareba W, Moss AJ. Left ventricular pacing threshold and outcome in MADIT-CRT. Cardiovasc Electrophysiol. 2014;25(9):1005–11.
Anderson SE, Iaizzo PA. Effects of left ventricular lead positions and coronary venous microanatomy on cardiac pacing parameters. J Electrocardiol. 2010;43:136–41.
El-Maasarany S, Ferrett CG, Firth A, Sheppard M, Henein MY. The coronary sinus conduit function: anatomical study (relationship to adjacent structures). Europace. 2005;7:475.
Sons HU, Hoffmann V. Epicardial fat cell size, fat distribution and fat infiltration of the right and left ventricle of the heart. Anat Anz. 1986;161:355.
La Rocca V, Bertaglia E, Solimene F, Accogli M, Iuliano A, Marrazzo N, et al. Clinical and technical determinants of long-term performance of coronary sinus leads. J Cardiovasc Med. 2010;11:40–4.
Iuliano A, Shopova G, De Simone A, Solimene F, Turco P, Marrazzo N, et al. Long-term performance of coronary sinus leads used for cardiac resynchronization therapy. PACE. 2007;30:S47–9.
Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Rev Esp Cardiol (Engl Ed). 2014;67(1):58.
Dohrmann ML, Goldschlager NF. Myocardial stimulation threshold in patients with cardiac pacemakers: effect of physiologic variables, pharmacologic agents. and lead electrodes. Cardiol Clin. 1985;3:527–37.
Tse HF, Yu C, Paul VE, Boriani G, Schuchert A, Del Ojo JL, et al. Effect of left ventricular function on long-term left ventricular pacing and sensing threshold. J Interv Card Electrophysiol. 2003;9(1):21–4.
Ballı M, Çetin M, Tasolar H, Tekin K, Çağlıyan ÇE, Türkmen S, et al. Increased ventricular pacing threshold levels in patients with high serum uric acid levels. J Cardiol. 2014;64(3):207–10.
Lee JH, O’Keefe JH, Bell D, Hensrud DD, Holick MF. Vitamin D deficiency: an important, common, and easily treatable cardiovascular risk factor? J Am Coll Cardiol. 2008;52:1949–56.
Giovannucci E, Liu Y, Hollis BW, Rimm EB. 25-hydroxyvitamin D and risk of myocardial infarction in men: a prospective study. Arch Intern Med. 2008;168:1174–80.
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Gözübüyük, G., Koç, M., Kaypaklı, O. et al. Increased hs-CRP and decreased 1,25-dihydroxyvitamin D are associated with increased left ventricle lead threshold. J Interv Card Electrophysiol 47, 177–183 (2016). https://doi.org/10.1007/s10840-016-0152-3
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DOI: https://doi.org/10.1007/s10840-016-0152-3