Key result
Left ventricular pacing significantly reduced the longest activation time (ATmax) to 103.7 ms compared to 128.1 ms during spontaneous rhythm in heart failure patients.
Why the study?
Do different pacing modes (RVP, LVP, BVP) improve body surface potential map parameters compared to spontaneous rhythm in heart failure patients with dyssynchrony?
Cross-Sectional (n=24)
No
Do different pacing modes (RVP, LVP, BVP) improve body surface potential map parameters compared to spontaneous rhythm in heart failure patients with dyssynchrony?
Absolute Event Rate: 103.7% vs 128.1%
p-value: p=<0.01
Left ventricular and biventricular pacing significantly improve electrical activation times and dispersion of repolarization in heart failure patients with dyssynchrony, returning activation times to a normal distribution.
LVP and BVP may acutely improve activation times in dyssynchronous HF; leaves open clinical outcome benefits.
Cardiac resynchronization therapy (CRT) has proven efficacious in reducing or even eliminating cardiac dyssynchrony and thus improving heart failure symptoms. However, quantification of mechanical dyssynchrony is still difficult and identification of CRT candidates is currently based just on the morphology and width of the QRS complex. As standard 12-lead ECG brings only limited information about the pattern of ventricular activation, we aimed to study changes produced by different pacing modes on the body surface potential maps (BSPM). Total of 12 CRT recipients with symptomatic heart failure (NYHA II-IV), sinus rhythm and QRS width >/=120 ms and 12 healthy controls were studied. Mapping system Biosemi (123 unipolar electrodes) was used for BSPM acquisition. Maximum QRS duration, longest and shortest activation times (ATmax and ATmin) and dispersion of QT interval (QTd) were measured and/or calculated during spontaneous rhythm, single-site right- and left-ventricular pacing and biventricular pacing with ECHO-optimized AV delay. Moreover we studied the impact of CRT on the locations of the early and late activated regions of the heart. The average values during the spontaneous rhythm in the group of patients with dyssynchrony (QRS 140.5+/-10.6 ms, ATmax 128.1+/-10.1 ms, ATmin 31.8+/-6.7 ms and QTd 104.3+/-24.7 ms) significantly differed from those measured in the control group (QRS 93.0+/-10.0 ms, ATmax 79.1+/-3.2 ms, ATmin 24.4+/-1.6 ms and QTd 43.6+/-10.7 ms). Right ventricular pacing (RVP) improved significantly only ATmax [111.2+/-10.6 ms (p<0.05)] but no other measured parameters. Left ventricular pacing (LVP) succeeded in improvement of all parameters [QRS 105.1+/-8.0 ms (p<0.01), ATmax 103.7+/-7.1 ms (p<0.01), ATmin 20.2+/-3.7 ms (p<0.01) and QTd 52.0+/-9.4 ms (p<0.01)]. Biventricular pacing (BVP) showed also a beneficial effect in all parameters [QRS 121.3+/-8.9 ms (p<0.05), ATmax 114.3+/-8.2 ms (p<0.05), ATmin 22.0+/-4.1 ms (p<0.01) and QTd 49.8+/-10.0 ms (p<0.01)]. Our results proved beneficial outcome of LVP and BVP in evaluated parameters (what seems to be important particularly in the case of activation times) and revealed a complete return of activation times to normal distribution when using these CRT modalities.
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Kittnar et al. (2017) conducted a cross-sectional in Heart failure with electrical dyssynchrony (n=24). Left ventricular pacing (LVP) vs. Spontaneous rhythm was evaluated on Longest activation time (ATmax) (p=<0.01). Left ventricular pacing significantly reduced the longest activation time (ATmax) to 103.7 ms compared to 128.1 ms during spontaneous rhythm in heart failure patients.
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