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Differential effect with septal and apical RV pacing on ventricular activation in patients with left bundle branch block assessed by non-invasive electrical imaging and in silico modelling
PURPOSE: It is uncertain whether right ventricular (RV) lead position in cardiac resynchronization therapy impacts response. There has been little detailed analysis of the activation patterns in RV septal pacing (RVSP), especially in the CRT population. We compare left bundle branch block (LBBB) act...
Autores principales: | , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Springer US
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036078/ https://www.ncbi.nlm.nih.gov/pubmed/31201592 http://dx.doi.org/10.1007/s10840-019-00567-2 |
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author | Jackson, T. Claridge, S. Behar, J. Sieniewicz, B. Gould, J. Porter, B. Sidhu, B. Yao, C. Lee, A. Niederer, S. Rinaldi, C. A. |
author_facet | Jackson, T. Claridge, S. Behar, J. Sieniewicz, B. Gould, J. Porter, B. Sidhu, B. Yao, C. Lee, A. Niederer, S. Rinaldi, C. A. |
author_sort | Jackson, T. |
collection | PubMed |
description | PURPOSE: It is uncertain whether right ventricular (RV) lead position in cardiac resynchronization therapy impacts response. There has been little detailed analysis of the activation patterns in RV septal pacing (RVSP), especially in the CRT population. We compare left bundle branch block (LBBB) activation patterns with RV pacing (RVP) within the same patients with further comparison between RV apical pacing (RVAP) and RVSP. METHODS: Body surface mapping was undertaken in 14 LBBB patients after CRT implantation. Nine patients had RVAP, 5 patients had RVSP. Activation parameters included left ventricular total activation time (LVtat), biventricular total activation time (VVtat), interventricular electrical synchronicity (VVsync), and dispersion of left ventricular activation times (LVdisp). The direction of activation wave front was also compared in each patient (wave front angle (WFA)). In silico computer modelling was applied to assess the effect of RVAP and RVSP in order to validate the clinical results. RESULTS: Patients were aged 64.6 ± 12.2 years, 12 were male, 8 were ischemic. Baseline QRS durations were 157 ± 18 ms. There was no difference in VVtat between RVP and LBBB but a longer LVtat in RVP (102.8 ± 19.6 vs. 87.4 ± 21.1 ms, p = 0.046). VVsync was significantly greater in LBBB (45.1 ± 20.2 vs. 35.9 ± 17.1 ms, p = 0.01) but LVdisp was greater in RVP (33.4 ± 5.9 vs. 27.6 ± 6.9 ms, p = 0.025). WFA did rotate clockwise with RVP vs. LBBB (82.5 ± 25.2 vs. 62.1 ± 31.7 (o)p = 0.026). None of the measurements were different to LBBB with RVSP; however, the differences were preserved with RVAP for VVsync, LVdisp, and WFA. In silico modelling corroborated these results. CONCLUSIONS: RVAP activation differs from LBBB where RVSP appears similar. TRIAL REGISTRATION: (ClinicalTrials.gov identifier: NCT01831518) ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10840-019-00567-2) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-7036078 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Springer US |
record_format | MEDLINE/PubMed |
spelling | pubmed-70360782020-02-24 Differential effect with septal and apical RV pacing on ventricular activation in patients with left bundle branch block assessed by non-invasive electrical imaging and in silico modelling Jackson, T. Claridge, S. Behar, J. Sieniewicz, B. Gould, J. Porter, B. Sidhu, B. Yao, C. Lee, A. Niederer, S. Rinaldi, C. A. J Interv Card Electrophysiol Multimedia Report PURPOSE: It is uncertain whether right ventricular (RV) lead position in cardiac resynchronization therapy impacts response. There has been little detailed analysis of the activation patterns in RV septal pacing (RVSP), especially in the CRT population. We compare left bundle branch block (LBBB) activation patterns with RV pacing (RVP) within the same patients with further comparison between RV apical pacing (RVAP) and RVSP. METHODS: Body surface mapping was undertaken in 14 LBBB patients after CRT implantation. Nine patients had RVAP, 5 patients had RVSP. Activation parameters included left ventricular total activation time (LVtat), biventricular total activation time (VVtat), interventricular electrical synchronicity (VVsync), and dispersion of left ventricular activation times (LVdisp). The direction of activation wave front was also compared in each patient (wave front angle (WFA)). In silico computer modelling was applied to assess the effect of RVAP and RVSP in order to validate the clinical results. RESULTS: Patients were aged 64.6 ± 12.2 years, 12 were male, 8 were ischemic. Baseline QRS durations were 157 ± 18 ms. There was no difference in VVtat between RVP and LBBB but a longer LVtat in RVP (102.8 ± 19.6 vs. 87.4 ± 21.1 ms, p = 0.046). VVsync was significantly greater in LBBB (45.1 ± 20.2 vs. 35.9 ± 17.1 ms, p = 0.01) but LVdisp was greater in RVP (33.4 ± 5.9 vs. 27.6 ± 6.9 ms, p = 0.025). WFA did rotate clockwise with RVP vs. LBBB (82.5 ± 25.2 vs. 62.1 ± 31.7 (o)p = 0.026). None of the measurements were different to LBBB with RVSP; however, the differences were preserved with RVAP for VVsync, LVdisp, and WFA. In silico modelling corroborated these results. CONCLUSIONS: RVAP activation differs from LBBB where RVSP appears similar. TRIAL REGISTRATION: (ClinicalTrials.gov identifier: NCT01831518) ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s10840-019-00567-2) contains supplementary material, which is available to authorized users. Springer US 2019-06-14 2020 /pmc/articles/PMC7036078/ /pubmed/31201592 http://dx.doi.org/10.1007/s10840-019-00567-2 Text en © The Author(s) 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. |
spellingShingle | Multimedia Report Jackson, T. Claridge, S. Behar, J. Sieniewicz, B. Gould, J. Porter, B. Sidhu, B. Yao, C. Lee, A. Niederer, S. Rinaldi, C. A. Differential effect with septal and apical RV pacing on ventricular activation in patients with left bundle branch block assessed by non-invasive electrical imaging and in silico modelling |
title | Differential effect with septal and apical RV pacing on ventricular activation in patients with left bundle branch block assessed by non-invasive electrical imaging and in silico modelling |
title_full | Differential effect with septal and apical RV pacing on ventricular activation in patients with left bundle branch block assessed by non-invasive electrical imaging and in silico modelling |
title_fullStr | Differential effect with septal and apical RV pacing on ventricular activation in patients with left bundle branch block assessed by non-invasive electrical imaging and in silico modelling |
title_full_unstemmed | Differential effect with septal and apical RV pacing on ventricular activation in patients with left bundle branch block assessed by non-invasive electrical imaging and in silico modelling |
title_short | Differential effect with septal and apical RV pacing on ventricular activation in patients with left bundle branch block assessed by non-invasive electrical imaging and in silico modelling |
title_sort | differential effect with septal and apical rv pacing on ventricular activation in patients with left bundle branch block assessed by non-invasive electrical imaging and in silico modelling |
topic | Multimedia Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7036078/ https://www.ncbi.nlm.nih.gov/pubmed/31201592 http://dx.doi.org/10.1007/s10840-019-00567-2 |
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