Impact of left ventricular pacing threshold on ventricular arrhythmia occurrence in cardiac resynchronization therapy

Background: Cardiac resynchronization therapy (CRT) is an established heart failure (HF) treatment option, however its effect on ventricular arrhythmias (VAs) is controversial. Regional scar burden and high left ventricular (LV) pacing threshold (PT) are associated with poor outcome in CRT patients. The aim of our study was to analyze the impact of intraoperative LVPT on VA occurrence. Methods: Eighty consecutive patients with advanced HF scheduled for a CRT defibrillator device [aged 63.3 +/- 10.9 years; New York Heart Association II-III 86.2%; 52 males (65%); 34 ischemic etiology (42.5%); 71 sinus rhythm (88.7%); QRS duration 168 +/- 25.7 ms] were evaluated using single-photon emission computed tomography myocardial perfusion imaging. Regional myocardial viability was calculated as the mean tracer activity in the corresponding segments at the LV lead pacing site. Fluoroscopic position and intraoperative LVPT were determined at implant after the final LV lead position was determined. Results: LVPT was inversely associated with regional myocardial viability (rho -0.785, p < 0.001). After a median follow-up of 36 months (24-57) months VAs were registered in 27 patients (33.7%). Patients with VAs had higher median intraoperative LVPT compared to those without VAs [2.2 V (1.9-2.8) vs. 0.8 V (0.61.2), p < 0.001]. In a multivariate logistic regression model intraoperative LVPT was identified as a strong independent predictor of VAs. Conclusion: Increased intraoperative LVPT during CRT could be associated with lower regional myocardial viability at LV lead location. CRT patients with higher LVPT could have an increased risk of VA occurrence. (C) 2019 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.