Changes in electrical dyssynchrony by body surface mapping predict left ventricular remodeling in patients with cardiac resynchronization therapy.
| Autor: | Gage RM; United Heart & Vascular Clinic, St. Paul, Minnesota., Curtin AE; University of Minnesota, Minneapolis, Minnesota., Burns KV; United Heart & Vascular Clinic, St. Paul, Minnesota., Ghosh S; Medtronic plc, Mounds View, Minnesota., Gillberg JM; Medtronic plc, Mounds View, Minnesota., Bank AJ; United Heart & Vascular Clinic, St. Paul, Minnesota; University of Minnesota, Minneapolis, Minnesota,. Electronic address: alan.bank@allina.com. |
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| Jazyk: | angličtina |
| Zdroj: | Heart rhythm [Heart Rhythm] 2017 Mar; Vol. 14 (3), pp. 392-399. Date of Electronic Publication: 2016 Nov 17. |
| DOI: | 10.1016/j.hrthm.2016.11.019 |
| Abstrakt: | Background: Electrical activation is important in cardiac resynchronization therapy (CRT) response. Standard electrocardiographic analysis may not accurately reflect the heterogeneity of electrical activation. Objective: We compared changes in left ventricular size and function after CRT to native electrical dyssynchrony and its change during pacing. Methods: Body surface isochronal maps using 53 anterior and posterior electrodes as well as 12-lead electrocardiograms were acquired after CRT in 66 consecutive patients. Electrical dyssynchrony was quantified using standard deviation of activation times (SDAT). Ejection fraction (EF) and left ventricular end-systolic volume (LVESV) were measured before CRT and at 6 months. Multiple regression evaluated predictors of response. Results: ∆LVESV correlated with ∆SDAT (P = .007), but not with ∆QRS duration (P = .092). Patients with SDAT ≥35 ms had greater increase in EF (13 ± 8 units vs 4 ± 9 units; P < .001) and LVESV (-34% ± 28% vs -13% ± 29%; P = .005). Patients with ≥10% improvement in SDAT had greater ∆EF (11 ± 9 units vs 4 ± 9 units; P = .010) and ∆LVESV (-33% ± 26% vs -6% ± 34%; P = .001). SDAT ≥35 ms predicted ∆EF, while ∆SDAT, sex, and left bundle branch block predicted ∆LVESV. In 34 patients without class I indication for CRT, SDAT ≥35 ms (P = .015) and ∆SDAT ≥10% (P = .032) were the only predictors of ∆EF. Conclusion: Body surface mapping of SDAT and its changes predicted CRT response better than did QRS duration. Body surface mapping may potentially improve selection or optimization of CRT patients. (Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.) |
| Databáze: | MEDLINE |
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