Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2009
Midterm 'super-response' to cardiac resynchronization therapy by biventricular pacing with fusion: insights from electro-anatomical mapping.
Клиническое исследованиеСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
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Vatasescu Radu, Berruezo Antonio, Mont Lluis, Tamborero David, Sitges Marta, Silva Etel, Tolosana Jose María, Vidal Bárbara, Andreu David, Brugada Josep
Аннотация
AIMS: Some authors recommend avoiding fusion with left ventricular (LV) intrinsic depolarization during cardiac resynchronization therapy (CRT). If fusion is still present during optimized biventricular (Biv) pacing and its long-term effects on the response to CRT are currently unknown. The aim of the study was to analyse the endocardial LV activation pattern induced by echocardiographically optimized Biv pacing and its influence on LV reverse remodelling.
METHODS AND RESULTS: Contact electro-anatomical mapping was performed in 15 heart failure (HF) patients with left bundle branch block and echocardiographically optimized CRT (seven ischaemic aetiology, 64 +/- 8 years, three women, New York Heart Association class 3 +/- 0.4, LV ejection fraction 25 +/- 5%). Left ventricular activation maps were performed in sinus rhythm (SR), during DDD right ventricular apical (RVA) and optimized Biv pacing. Fusion with intrinsic rhythm during pacing was considered when LV septal activation was produced at least partially by intrinsic depolarization, when compared with LV activation map during SR. Patients were considered responders to CRT if they had > or =10% reduction in LV end-systolic volume (LVESV) after 6 months of CRT. During SR, the LV breakthrough was mid-septal (n = 12), basal septum (n = 2), and apical (n = 1). During RVA pacing, LV breakthrough shifted apical in all patients. Right ventricular apical/Biv pacing proved fusion with intrinsic depolarization in 8 of 15 patients. The PR interval was shorter in patients with fusion RVA/Biv pacing (164 +/- 24 vs. 234 +/- 55 ms, P = 0.006). There was a trend for shorter LV activation time (LV(at)) in patients with fusion during RVA pacing (87 +/- 33 vs. 113 +/- 21 ms, P = 0.08) as well as during optimized Biv pacing (83 +/- 18 vs. 104 +/- 24 ms, P = 0.07), although LV(at) was similar in SR (100 +/- 22 vs. 106 +/- 20, P = NS). In patients with fusion, 6 months responder rate was significantly higher (100 vs. 28.5%, P < 0.007) as was the degree of LVESV reduction (39 +/- 17 vs. 1.0 +/- 14%, P < 0.001).
CONCLUSION: Biventricular pacing with fusion may substantially increase the structural responder rate probably by shortening LV(at).
METHODS AND RESULTS: Contact electro-anatomical mapping was performed in 15 heart failure (HF) patients with left bundle branch block and echocardiographically optimized CRT (seven ischaemic aetiology, 64 +/- 8 years, three women, New York Heart Association class 3 +/- 0.4, LV ejection fraction 25 +/- 5%). Left ventricular activation maps were performed in sinus rhythm (SR), during DDD right ventricular apical (RVA) and optimized Biv pacing. Fusion with intrinsic rhythm during pacing was considered when LV septal activation was produced at least partially by intrinsic depolarization, when compared with LV activation map during SR. Patients were considered responders to CRT if they had > or =10% reduction in LV end-systolic volume (LVESV) after 6 months of CRT. During SR, the LV breakthrough was mid-septal (n = 12), basal septum (n = 2), and apical (n = 1). During RVA pacing, LV breakthrough shifted apical in all patients. Right ventricular apical/Biv pacing proved fusion with intrinsic depolarization in 8 of 15 patients. The PR interval was shorter in patients with fusion RVA/Biv pacing (164 +/- 24 vs. 234 +/- 55 ms, P = 0.006). There was a trend for shorter LV activation time (LV(at)) in patients with fusion during RVA pacing (87 +/- 33 vs. 113 +/- 21 ms, P = 0.08) as well as during optimized Biv pacing (83 +/- 18 vs. 104 +/- 24 ms, P = 0.07), although LV(at) was similar in SR (100 +/- 22 vs. 106 +/- 20, P = NS). In patients with fusion, 6 months responder rate was significantly higher (100 vs. 28.5%, P < 0.007) as was the degree of LVESV reduction (39 +/- 17 vs. 1.0 +/- 14%, P < 0.001).
CONCLUSION: Biventricular pacing with fusion may substantially increase the structural responder rate probably by shortening LV(at).