Electrical remodelling in patients with iatrogenic left bundle branch block
| Autor: | Kevin Vernooy, Peter de Jaegere, Patrick Houthuizen, Thomas T. Poels, Frits W. Prinzen, Jos G. Maessen, Elien B. Engels |
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| Přispěvatelé: | Cardiology, RS: CARIM - R2.08 - Electro mechanics, Fysiologie, MUMC+: MA Med Staf Artsass CTC (9), Promovendi CD, MUMC+: MA Cardiothoracale Chirurgie (3), RS: CARIM - R2.12 - Surgical intervention, CTC, Cardiologie, RS: CARIM - R2.01 - Clinical atrial fibrillation, MUMC+: MA Med Staf Spec Cardiologie (9) |
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
Male
Patient-Specific Modeling medicine.medical_specialty Bundle of His Electrical remodelling Time Factors Bundle-Branch Block Iatrogenic Disease Vectorcardiography Action Potentials 030204 cardiovascular system & hematology Narrow QRS complex Transcatheter Aortic Valve Replacement 03 medical and health sciences QRS complex Electrocardiography 0302 clinical medicine Heart Rate Predictive Value of Tests Physiology (medical) Internal medicine medicine Repolarization Humans In patient 030212 general & internal medicine Aged Netherlands Retrospective Studies Aged 80 and over Transcatheter aortic valve implantation medicine.diagnostic_test business.industry Left bundle branch block Models Cardiovascular Retrospective cohort study Signal Processing Computer-Assisted medicine.disease Anesthesia Cardiology Action potential duration Female sense organs Cardiology and Cardiovascular Medicine business |
| Zdroj: | Europace, 18, 44-52. Oxford University Press EP Europace, 18(Suppl_4), 44-52. Oxford University Press |
| ISSN: | 1099-5129 |
| DOI: | 10.1093/europace/euw350 |
| Popis: | Aims Left bundle branch block (LBBB) is induced in approximately one-third of all transcatheter aortic valve implantation (TAVI) procedures. We investigated electrophysiological remodelling in patients with TAVI-induced LBBB. Methods and results This retrospective study comprises 107 patients with initially narrow QRS complex of whom 40 did not and 67 did develop persistent LBBB after TAVI. 12-lead electrocardiograms (ECGs) taken before TAVI, within 24 hours (‘acute’), and 1–12 months after TAVI (‘chronic’) were used to reconstruct vectorcardiograms. From these vectorcardiograms, QRS and T-wave area were calculated as comprehensive indices of depolarization and repolarization abnormalities, respectively. TAVI-induced LBBB resulted in significant acute depolarization and repolarization changes while further repolarization changes were observed with longer lasting LBBB. The amount of long-term repolarization changes (remodelling) was highly variable between patients. The change in T-wave area between acute and chronic LBBB ranged from +57% to − 77%. After dividing the LBBB cohort into tertiles based on the change in T-wave area, only baseline QRS area was larger in the tertile with no significant change in T-wave area. During longer lasting LBBB, the spatial vector gradient (SVG) changed orientation towards the direction of the QRS-vector, indicating that later-activated regions developed shorter action potential duration. Conclusion This study in patients with TAVI-induced LBBB shows that repolarization changes develop within months after onset of LBBB, and that these changes are highly variable between individual patients. |
| Databáze: | OpenAIRE |
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