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A high percentage of BiV pacing is associated with improved cardiac resynchronization therapy (CRT) response.1 However, the presence of a pacing stimulus does not imply full capture.2,3 Traditional pacing counters only report the presence of a pacing stimulus, potentially leading to over-reporting of effective pacing.2,3
You can now verify effective pacing with the EffectivCRT™ diagnostic.
The EffectivCRT™ diagnostic uses a unipolar electrogram to evaluate morphology, looking for a negative deflection which implies when a paced beat is effective.4
This EGM strip shows six consecutive paced beats.
Traditional pacing counters would report this as 100% V pacing.
With the EffectivCRT™ diagnostic, it would report 100% V pacing, but 50% is effective pacing.
The first three beats are ineffective (positive deflection implies tissue is paced and not captured).
The last three beats are effective (negative deflection implies tissue is paced and captured).
In 18% of patients, device-reported % V pacing overestimated effective CRT by 3%. Three out of 57 patients had virtually no effective pacing, whereas the % V pacing was > 90%, as demonstrated in the graph below.5
Before the EffectivCRT™ diagnostic:
Only see the quantity of pacing5
With the EffectivCRT™ diagnostic:
Also see the quality of pacing5
You can use the data provided by the EffectivCRT™ diagnostic to identify ineffective pacing and will find it in these places:
Hayes DL, Boehmer JP, Day JD, et al. Cardiac resynchronization therapy and the relationship of percent biventricular pacing to symptoms and survival. Heart Rhythm. 2011;8:1469–1475. doi: 10.1016/j.hrthm.2011.04.015.
Daubert JC, Saxon L, Adamson PB, et al. EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management. Heart Rhythm. 2012;9:1524–1576. doi.org/10.1016/j.hrthm.2012.07.025.
Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J. 2013;34:2281–2329. doi: 10.1093/eurheartj/eht150.
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