Electrical approach to improve left ventricular activation during right ventricle stimulation
María Paula Bonomini1,2, Daniel F Ortega3, Luis D Barja3
1Instituto de Ingeniería Biomédica, Facultad de Ingeniería, Universidad de Buenos Aires (FIUBA), Argentina.
Medicina
|February 1, 2017
Summary
Coronary sinus mapping can identify optimal right ventricular pacing sites. The SEPHO pacing modality effectively shortens left ventricular activation times and narrows QRS widths, particularly in patients with left bundle branch block.
Area of Science:
- Cardiology
- Electrophysiology
- Cardiac Pacing
Background:
- Coronary sinus (CS) mapping is standard for evaluating left atrial activation.
- Its utility in assessing right ventricular (RV) pacing effects on left ventricular (LV) activation and QRS width is less explored.
- Intraventricular conduction disturbances, like bundle branch blocks, significantly impact cardiac electrical activity.
Purpose of the Study:
- To evaluate RV pacing modalities using CS mapping to determine the optimal site for shortest LV activation times (R-LVtime) and narrowest QRS widths.
- To assess the impact of different RV pacing sites on patients with and without conduction disturbances.
- To identify potential non-responders to cardiac resynchronization therapy (CRT).
Main Methods:
- CS mapping was employed to measure R-LVtime and QRS widths in three groups: controls, patients with left bundle branch block (LBBB), and patients with right bundle branch block (RBBB).
- Pacing was performed at the RV apex, RV outflow tract, and a high output septal zone (SEPHO).
- Electrical differences from CS mapping correlated with mechanical differences measured by tissue Doppler imaging.
Main Results:
- SEPHO pacing significantly improved QRS widths and R-LVtime across all groups, especially in LBBB patients, normalizing values compared to controls.
- A subset of LBBB patients (33%) showed early LV activation, suggesting they might not benefit from CRT.
- CS mapping effectively differentiated electrical and mechanical responses to various pacing modalities.
Conclusions:
- CS mapping is valuable for optimizing RV pacing site selection and identifying non-responders to CRT.
- The SEPHO pacing modality emerged as superior, narrowing QRS complexes and shortening LV activation in LBBB patients while preserving physiological depolarization in controls.
- This approach aids in tailoring pacing strategies for improved cardiac function and CRT efficacy.
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