Dispersion of repolarization in cardiac resynchronization therapy
| Autor: | Sander G. Molhoek, Bart Hooft van Huysduynen, Jeroen J. Bax, Martin J. Schalij, Cees A. Swenne, Lieselot van Erven, Ernst E. van der Wall, Hedde van de Vooren, Gabe B. Bleeker, Harmen H.M. Draisma |
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| Rok vydání: | 2005 |
| Předmět: |
Male
Pacemaker Artificial medicine.medical_specialty medicine.medical_treatment Epicardial pacing Transmural dispersion Cardiac resynchronization therapy Electrocardiography Physiology (medical) Internal medicine Ventricular Dysfunction medicine Humans Repolarization Computer Simulation In patient Statistical dispersion cardiovascular diseases Aged Heart Failure medicine.diagnostic_test business.industry Body Surface Potential Mapping Cardiac Pacing Artificial Models Cardiovascular medicine.disease Heart failure cardiovascular system Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart Rhythm. 2:1286-1293 |
| ISSN: | 1547-5271 |
| DOI: | 10.1016/j.hrthm.2005.08.031 |
| Popis: | BACKGROUND Proarrhythmic effects of cardiac resynchronization therapy (CRT) as a result of increased transmural dispersion of repolarization (TDR) induced by left ventricular (LV) epicardial pacing in a subset of vulnerable patients have been reported. The possibility of identifying these patients by ECG repolarization indices has been suggested. OBJECTIVES The purpose of this study was to test whether repolarization indices on the ECG can be used to measure dispersion of repolarization during pacing. METHODS CRT devices of 28 heart failure patients were switched among biventricular, LV, and right ventricular (RV) pacing. ECG indices proposed to measure dispersion of repolarization were calculated. The effects of CRT on repolarization were simulated in ECGSIM, a mathematical model of electrocardiogram genesis. TDR was calculated as the difference in repolarization time between the epicardial and endocardial nodes of the heart model. RESULTS Patients: The interval from the apex to the end of the T wave was shorter during biventricular pacing (102 18 ms) and LV pacing (106 21 ms) than during RV pacing (117 22 ms, P .005). T-wave amplitude and area were low during biventricular pacing (287 125 V and 56 22 V·s , respectively, P .0006 vs RV pacing). T-wave complexity was high during biventricular pacing (0.42 0.26, P .004 vs RV pacing). Simulations: Repolarization patterns were highly similar to the preceding depolarization patterns. The repolarization patterns of different pacing modes explained the observed magnitudes of the ECG repolarization indices. Average and local TDR were not different between pacing modes. CONCLUSION In patients treated with CRT, ECG repolarization indices are related to pacing-induced activation sequences rather than transmural dispersion. TDR during biventricular and LV pacing is not larger than TDR during conventional RV endocardial pacing. |
| Databáze: | OpenAIRE |
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