A Case with no Hemodynamic Benefit from Right Ventricular Anodal Capture during Biventricular Pacing

This case report describes a patient with a biventricular pacing system in whom right ventricular anodal capture had no hemodynamic benefit. While controlling the ventricular output, three morphologies of the paced QRS complex were obtained: right ventricular stimulation, biventricular stimulation, and biventricular pacing with additional stimulation from the anodal electrode in the right ventricle. While the QRS duration was 5 ms longer, the left ventricular systolic pressure and dP/dtmax during biventricular pacing without anodal capture of the right ventricle were greater than that during biventricular pacing with anodal capture. To avoid useless high output settings, the hemodynamic and clinical data should be compared with and without right ventricular anodal capture in each individual patient.