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Safety and efficacy of external electrical cardioversion in patients with left ventricular leads

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Abstract

Background

Atrial arrhythmias lower the biventricular pacing percentage in cardiac resynchronization therapy (CRT) treated patients (pts) and have a high prevalence in this population. External electrical cardioversion (ECV) is commonly performed to restore sinus rhythm. There is a paucity of data on the safety and efficacy of ECV in pts with CRT devices.

Methods

Forty-three pts with CRT devices undergoing ECV at two centers were included prospectively. Devices were interrogated immediately prior to and after ECV, as well as after 4 weeks.

Results

Devices (CRT-D in 38 and CRT-P in 5) were all implanted in left pectoral position, with predominantly bipolar left ventricular (LV) leads. Sixty-one shocks were delivered, all biphasic. Arrhythmia had recurred in 36 % of pts at follow-up (FU). There was a significant increase in LV lead threshold voltage and drop in bipolar LV lead impedance after ECV, which returned to normal at FU. An at least twofold increase in pacing threshold voltage at FU was seen in 2 LV leads and a 0.5 V increase in threshold in 3 LV leads. Overall, biventricular pacing significantly increased during FU.

Conclusion

ECV in CRT pts was safe and effective in this two-center study. A transient increase in LV lead pacing threshold was observed. Relevant changes in pacing threshold at FU occurred in five LV leads—identification and regular FU of these pts are necessary. Restoring SR through ECV significantly increased the biventricular pacing percentage but arrhythmia recurrence was frequent. CRT pts with atrial arrhythmias require close FU after ECV.

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Abbreviations

AF:

Atrial fibrillation

CRT:

Cardiac resynchronization therapy

ECV:

External electrical cardioversion

FU:

Follow-up

LV:

Left ventricular

TOE:

Transoesophageal echocardiography

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Conflict of interest

None of the authors have a conflict of interest to report.

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Authors and Affiliations

  1. Department of Electrophysiology, Heart Center, University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany

    Jakob Lüker, Arian Sultan & Daniel Steven

  2. Department of Electrophysiology, University Heart Center Hamburg, Hamburg, Germany

    Ruken Ö. Akbulak, Benjamin Schäffer, Doreen Schreiber, Boris A. Hoffmann & Stephan Willems

  3. Department of Cardiology, Clinic Augustinum, Munich, Germany

    Georg von Bodman, Jürgen Brömsen & Michael Block

Authors
  1. Jakob Lüker
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  2. Georg von Bodman
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  3. Arian Sultan
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  4. Jürgen Brömsen
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  5. Ruken Ö. Akbulak
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  6. Benjamin Schäffer
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  7. Doreen Schreiber
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  8. Boris A. Hoffmann
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  9. Michael Block
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  10. Stephan Willems
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  11. Daniel Steven
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Correspondence to Jakob Lüker.

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Lüker, J., von Bodman, G., Sultan, A. et al. Safety and efficacy of external electrical cardioversion in patients with left ventricular leads. Clin Res Cardiol 104, 439–445 (2015). https://doi.org/10.1007/s00392-014-0800-5

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  • DOI: https://doi.org/10.1007/s00392-014-0800-5

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