Pacing & Defibrillation

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AV crosstalk

Patient

Demo mode with a Abbott triple chamber defibrillator with quadripolar lead.



Trace

  1. programming for measurement of the LV activation time during spontaneous rhythm. Prolonged AV delay to promote spontaneous conduction.
  2. during spontaneous rhythm, the activation of the Proximal 4 electrode (188 ms) was the latest compared with the other 3 (from 145 to 186 ms).
  3. programming to measure the LV activation time after RV stimulation. The AV delay was short to promote capture.
  4. during RV stimulation, the activation of the Proximal 4 electrode (188 ms) was the latest compared with the other 3 (from 145 to 186 ms).

Comments

The LV stimulation site is probably a major determinant of the degree of response to resynchronization. The implantation of a quadripolar lead offers several important options with respect to LV stimulation. Several studies have recommended the stimulation of the most delayed LV wall during spontaneous rhythm as well as during RV stimulation. The Abbott defibrillators measure the activation delays during spontaneous rhythm and during RV stimulation of the 4 LV electrodes, allowing a choice of corresponding configuration of stimulation. Its clinical merit remains to be shown.

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