Electrical dyssynchrony mapping and cardiac resynchronization therapy.

Autor: Bank AJ; Minneapolis Heart Institute East, Allina Health, St. Paul, MN, USA; Cardiology Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA. Electronic address: Alan.Bank@allina.com., Brown CD; Minneapolis Heart Institute East, Allina Health, St. Paul, MN, USA., Burns KV; Minneapolis Heart Institute East, Allina Health, St. Paul, MN, USA., Espinosa EA; Minneapolis Heart Institute East, Allina Health, St. Paul, MN, USA., Harbin MM; Minneapolis Heart Institute East, Allina Health, St. Paul, MN, USA.
Jazyk: angličtina
Zdroj: Journal of electrocardiology [J Electrocardiol] 2022 Sep-Oct; Vol. 74, pp. 73-81. Date of Electronic Publication: 2022 Aug 27.
DOI: 10.1016/j.jelectrocard.2022.08.006
Abstrakt: Purpose: There is no clinical methodology for quantification or display of electrical dyssynchrony over a wide range of atrial-ventricular delays (AVD) and ventricular-ventricular delays (VVD) in patients with cardiac resynchronization therapy (CRT). This study aimed to develop a new methodology, based on wavefront fusion, for mapping electrical synchrony.
Methods: A cardiac resynchronization index (CRI) was measured at multiple device settings in 90 patients. Electrical dyssynchrony maps (EDM) were constructed for each patient to display CRI at any combination of AVD and VVD. An optimal synchrony line (OSL) depicted the AVD/VVD combinations producing the highest CRIs. Fusion of right ventricular paced (RVp), left ventricular paced (LVp), and native wavefront offsets were calculated.
Results: CRI significantly increased (p < 0.0001) from 58.0 ± 28.1% at baseline to 98.3 ± 1.7% at optimized settings. EDMs in patients with high-grade heart block (n = 20) had an OSL parallel to the simultaneous biventricular pacing (BiVP VV-SIM ) line with leftward shift across all AVDs (RVp-LVp OFFSET  = 50.5 ± 29.8 ms). EDMs in patients with intact AV node conduction (n = 64) had an OSL parallel to the BiVP VV-SIM line with leftward shift at short AVDs (RVp-LVp OFFSET  = 33.4 ± 23.3 ms), curvilinear at intermediate AVDs (triple fusion), and vertical at long AVDs (native-LVp OFFSET  = 85.2 ± 22.8 ms) in all patients except those with poor LV lead position (n = 6).
Conclusion: A new methodology is described for quantifying and graphing electrical dyssynchrony over a physiologic range of AVDs/VVDs. This methodology offers a noninvasive, practical, clinical approach for measuring electrical synchrony that could be applied to optimization of CRT devices.
Competing Interests: Declaration of Competing Interest Dr. Alan J. Bank and Dr. Kevin V. Burns own patents related to the methods and technologies used in this manuscript. The technologies are licensed to Medtronic and Dr. Alan Bank and Dr. Kevin Burns may receive royalties if the licensed technologies are commercialized. Dr. Alan Bank has received compensation for consulting with Medtronic.
(Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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