Networked multielectrode left ventricular pacing lead for avoidance of phrenic nerve stimulation in a canine model

Liliane Wecke, Arne van Hunnik, Todd Thompson, Lorenzo DiCarlo, Mark Zdeblick, Angelo Auricchio, Frits W. Prinzen*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

5 Citations (Web of Science)

Abstract

BACKGROUND In cardiac resynchronization therapy, left ventricular stimulation may lead to concomitant phrenic nerve stimulation (PNS). OBJECTIVE To evaluate a new networked multielectrode lead with 16 electrode segments (SEGs) configured into groups of 4, forming a virtual band (VBAND) around the lead. Each electrode is individually programmable using an embedded integrated circuit. METHODS In 8 anesthetized dogs, the lead was positioned in a left ventricular coronary vein. The voltage thresholds for cardiac stimulation and PNS were measured for different electrode configurations, including "VBAND-VBAND" (similar to conventional bipolar pacing), "SEG-VBAND", and "SEG-SEG" (anode and cathode within the same VBAND). The measurements were performed (1) with closed chest and (2) after opening the chest and repositioning the phrenic nerve to above the lead, simulating a worst-case scenario. RESULTS Compared with the conventional VBAND-VBAND stimulation, the SEG-SEG stimulation increased the PNS threshold and raised the difference between phrenic and cardiac thresholds from 6.2 +/- 2.3 to 9.5 +/- 0.3 V in the closed chest condition and from 1.4 +/- 1.6 to 9.0 +/- 1.0 V in the worst-case scenario (both P <.001). Both SEG-VBAND and SEG-SEG stimulations reduced the cardiac threshold and increased pacing impedance, thus reducing the required cardiac pacing power by 77%-80% (P <.001 and P <.01 for closed and open chest, respectively). CONCLUSION This novel multielectrode pacing lead achieves low cardiac and high extracardiac stimulation thresholds during left ventricular pacing in a canine model. The virtual elimination of PNS may facilitate and improve the application of cardiac resynchronization therapy.
Original languageEnglish
Pages (from-to)789-795
JournalHeart Rhythm
Volume9
Issue number5
DOIs
Publication statusPublished - May 2012

Keywords

  • Left ventricular pacing lead
  • Cardiac resynchronization therapy
  • CRT
  • Phrenic nerve stimulation
  • Multielectrode
  • Pacing threshold

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