The proarrhythmic effects of cardiac resynchronisation therapy and the treatment options
Mikler Csaba1, Bihari Zoltán1, Görögh Péter1, Clemens Marcell2, Nagy Gergely György1
1Borsod-Abaúj Zemplén Megyei Központi Kórház és Egyetemi Oktatókórház, I. sz. Belgyógyászat – Kardiológiai Osztály, Miskolc
2Debreceni Egyetem, Klinikai Központ, Kardiológiai Intézet, Debrecen
Cardiac resynchronisation therapy (CRT) associated proarrhythmia is a rare complication of CRT. It is most commonly caused by the altered activation pattern of the left ventricle due to left ventricular pacing, which can lead to ventricular arrhythmias. There are several, in many cases contradictory publications regarding the pro- and antiarrhythmic effects of CRT. Despite the early skepticism surrounding cardiac resynchronisation, recently its safety became well-founded and it achieved a prime role in the device treatment of patients suffering from heart failure with reduced ejection fraction. The favorable clinical safety and efficacy data, the better understanding of the pathomechanisms leading to proarrhythmia and the newly evolved effective treatment options of proarrhythmic events all contributed to alleviating safety concerns. It seems that the net result of pro- and antiarrhythmic effects significantly favors the later, therefore CRT can provide substantial mortality benefit if the indication is chosen properly. The proarrhytmic effects of cardiac resynchronisation and their potential treatment options are summarized based on data from the literature.