Intentional anodal capture of a left ventricular quadripolar lead enhances resynchronization equally with multipoint pacing Itsuro Morishima, MD, PhD,

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Intentional anodal capture of a left ventricular quadripolar lead enhances resynchronization equally with multipoint pacing Itsuro Morishima, MD, PhD, Toshiro Tomomatsu, MD, Yasuhiro Morita, MD, Hideyuki Tsuboi, MD, PhD HeartRhythm Case Reports Volume 1, Issue 5, Pages 386-388 (September 2015) DOI: 10.1016/j.hrcr.2015.06.016 Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 1 Changes in the 12-lead electrocardiograms (ECGs) during biventricular pacing with different left ventricular (LV) pacing configurations. A: Extended bipolar pacing between LV1 and right ventricular coil. B: Extended bipolar pacing between LV4 and right ventricular coil. C: LV bipolar pacing between LV1 (anode) and LV4 (cathode) with an output of 4.0 V/0.4 ms. The similar morphology to ECG A indicates anodal capture. D:LV bipolar pacing between LV1 (anode) and LV4 (cathode) with an output of the anodal capture threshold of 3.5 V/0.4 ms. An alternative appearance of ECGs B and C is shown. The morphology identical to ECG B (asterisks) indicates a loss of anodal capture. HeartRhythm Case Reports 2015 1, 386-388DOI: (10.1016/j.hrcr.2015.06.016) Copyright © 2015 Heart Rhythm Society Terms and Conditions

Figure 2 Acute hemodynamic changes with and without left ventricular (LV) anodal capture during biventricular pacing. LV bipolar pacing was performed with LV1 used as the anode and LV4 as the cathode. The LV dP/dt max immediately increased with anodal capture and was accompanied by a QRS shortening and increase in the LV systolic pressure. LAO = left anterior oblique; LVP = left ventricular pressure; RAO = right anterior oblique; RV = right ventricle. HeartRhythm Case Reports 2015 1, 386-388DOI: (10.1016/j.hrcr.2015.06.016) Copyright © 2015 Heart Rhythm Society Terms and Conditions