Characteristics of cardiac memory in patients with implanted cardioverter-defibrillators: The cardiac memory with implantable cardioverter-defibrillator (CAMI) study

This study sought to determine factors associated with cardiac memory (CM) in patients with implantable cardioverter-defibrillators (ICDs). Patients with structural heart disease [n = 20; mean age: 72.6 ± 11.6 years; 80% male; mean left ventricular ejection fraction (LVEF): 31.7 ± 7.6%; history of myocardial infarction in 75% and nonsustained ventricular tachycardia (NSVT) in 85%] and preserved atrioventricular conduction received dual-chamber ICDs for primary (80%) or secondary (20%) prevention. Standard 12-lead electrocardiograms were recorded in AAI and DDD modes before and after seven days of right ventricular (RV) pacing in DDD mode with a short atrioventricular delay. The direction (azimuth and elevation) and magnitude of spatial QRS, T, and spatial ventricular gradient vectors were measured before and after seven days of RV pacing. CM was quantified as the degree of alignment between QRS_DDD-7 and T_AAI-7 vectors (QRS_DDD-7 -T_AAI-7 angle). Circular statistics and mixed models with a random slope and intercept were adjusted for changes in cardiac activation, LVEF, known risk factors, and the use of medications known to affect CM occurring on days 1 through 7. The QRS_DDD-7-T_AAI-7 angle strongly correlated (circular r = −0.972; p < 0.0001) with a T_AAI-7-T_DDD-7 angle. In the mixed models, CM-T azimuth changes [+132° (95% confidence interval (CI): 80°-184°); p < 0.0001] were counteracted by the history of MI [−180° (95% CI: −320° to −40°); p = 0.011] and female sex [−162° (95% CI: −268° to −55°); p = 0.003]. A CM-T area increase [+15 (95% CI: 6-24) mV*ms; p < 0.0001] was amplified by NSVT history [+27 (95% CI: 4-46) mV*ms; p = 0.007]. These findings suggest that preexistent electrical remodeling affects CM in response to RV pacing, that CM exhibits saturation behavior, and that women reach CM saturation more easily than men.