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Nguyên UC, Prinzen FW, Vernooy K. Left ventricular lead placement in cardiac resynchronization therapy: Current data and potential explanations for the lack of benefit. Heart Rhythm 2024; 21:197-205. [PMID: 37806647 DOI: 10.1016/j.hrthm.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
The present article reviews the literature on image-guided cardiac resynchronization therapy (CRT) studies. Improved outcome to CRT has been associated with the placement of a left ventricular (LV) lead in the latest activated segment free from scar. The majority of randomized controlled trials investigating guided LV lead implantation did not show superiority over conventional implantation approaches. Several factors may contribute to this paradoxical observation, including inclusion criteria favoring patients with left bundle branch block who already respond well to conventional anatomical LV lead implantation, differences in activation wavefronts during simultaneous right ventricular and LV pacing, incorrect definition of target regions, and limitations in coronary venous anatomy that prevent access to target regions that are detected by imaging. It is imperative that exclusion of patients lacking access to target regions from these studies would lead to larger benefit of image-guided CRT.
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Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands; Department of Cardiology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.
| | - Frits W Prinzen
- Department of Physiology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands
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2
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Hara H, Igarashi T, Kaida T, Murakami M, Ito H, Niwano S, Ako J. Estimation of left ventricular activation sequence in patients with heart failure using two-dimensional speckle tracking echocardiography. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1251-1262. [PMID: 36971867 DOI: 10.1007/s10554-023-02834-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/10/2023] [Indexed: 06/09/2023]
Abstract
Evaluation of longitudinal strain (LS) from two-dimensional echocardiography is useful for global and regional left ventricular (LV) dysfunction assessment. We determined whether the LS reflects contraction process in patients with asynchronous LV activation. We studied 144 patients with an ejection fraction ≤ 35%, who had left bundle branch block (LBBB, n = 42), right ventricular apical (RVA) pacing (n = 34), LV basal- or mid-lateral pacing (n = 23), and no conduction block (Narrow-QRS, n = 45). LS distribution maps were constructed using 3 standard apical views. The times from the QRS onset-to-early systolic positive peak (Q-EPpeak) and late systolic negative peak (Q-LNpeak) were measured to determine the beginning and end of contractions in each segment. Negative strain in LBBB initially appeared in the septum and basal-lateral contracted late. In RVA and LV pacing, the contracted area enlarged centrifugally from the pacing site. Narrow-QRS showed few regional differences in strain during the systolic period. The Q-EPpeak and Q-LNpeak exhibited similar sequences characterized by septum to basal-lateral via the apical regions in LBBB, apical to basal regions in RVA pacing, and lateral to a relatively large delayed contracted area between the apical- and basal-septum in LV pacing. Differences in Q-LNpeaks between the apical and basal segments in delayed contracted wall were 107 ± 30 ms in LBBB, 133 ± 46 ms in RVA pacing, and 37 ± 20 ms in LV pacing (p < 0.05, between QRS groups). Specific LV contraction processes were demonstrated by evaluating the LS distribution and time-to-peak strain. These evaluations may have potential to estimate the activation sequence in patients with asynchronous LV activation.
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Affiliation(s)
- Hideyuki Hara
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan.
| | - Tazuru Igarashi
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Toyoji Kaida
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Masami Murakami
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Hiroshi Ito
- Division of Cardiology, Numazu City Hospital, Aza-Harunoki 550, Higashi-Shiiji, Numazu City, Shizuoka Prefecture, 410-0302, Japan
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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3
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Chen Z, Zhou X, Ma X, Chen K. Recruitment of the cardiac conduction system for optimal resynchronization therapy in failing heart. Front Physiol 2022; 13:1045740. [PMID: 36589433 PMCID: PMC9798297 DOI: 10.3389/fphys.2022.1045740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
Abstract
Heart failure (HF) is a leading health burden around the world. Although pharmacological development has dramatically advanced medication therapy in the field, hemodynamic disorders or mechanical desynchrony deteriorated by intra or interventricular conduction abnormalities remains a critical target beyond the scope of pharmacotherapy. In the past 2 decades, nonpharmacologic treatment for heart failure, such as cardiac resynchronization therapy (CRT) via biventricular pacing (BVP), has been playing an important role in improving the prognosis of heart failure. However, the response rate of BVP-CRT is variable, leaving one-third of patients not benefiting from the therapy as expected. Considering the non-physiological activation pattern of BVP-CRT, more efforts have been made to optimize resynchronization. The most extensively investigated approach is by stimulating the native conduction system, e.g., His-Purkinje conduction system pacing (CSP), including His bundle pacing (HBP) and left bundle branch area pacing (LBBAP). These emerging CRT approaches provide an alternative to traditional BVP-CRT, with multiple proof-of-concept studies indicating the safety and efficacy of its utilization in dyssynchronous heart failure. In this review, we summarize the mechanisms of dyssynchronous HF mediated by conduction disturbance, the rationale and acute effect of CSP for CRT, the recent advancement in clinical research, and possible future directions of CSP.
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Affiliation(s)
- Zhongli Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Xuan Ma
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,*Correspondence: Keping Chen,
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Maffessanti F, Jadczyk T, Wilczek J, Conte G, Caputo ML, Gołba KS, Biernat J, Cybulska M, Caluori G, Regoli F, Krause R, Wojakowski W, Prinzen FW, Auricchio A. Electromechanical factors associated with favourable outcome in cardiac resynchronization therapy. Europace 2022; 25:546-553. [PMID: 36106562 PMCID: PMC9935025 DOI: 10.1093/europace/euac157] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/08/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Electromechanical coupling in patients receiving cardiac resynchronization therapy (CRT) is not fully understood. Our aim was to determine the best combination of electrical and mechanical substrates associated with effective CRT. METHODS AND RESULTS Sixty-two patients were prospectively enrolled from two centres. Patients underwent 12-lead electrocardiogram (ECG), cardiovascular magnetic resonance (CMR), echocardiography, and anatomo-electromechanical mapping (AEMM). Remodelling was measured as the end-systolic volume (ΔESV) decrease at 6 months. CRT was defined effective with ΔESV ≤ -15%. QRS duration (QRSd) was measured from ECG. Area strain was obtained from AEMM and used to derive systolic stretch index (SSI) and total left-ventricular mechanical time. Total left-ventricular activation time (TLVAT) and transeptal time (TST) were derived from AEMM and ECG. Scar was measured from CMR. Significant correlations were observed between ΔESV and TST [rho = 0.42; responder: 50 (20-58) vs. non-responder: 33 (8-44) ms], TLVAT [-0.68; 81 (73-97) vs. 112 (96-127) ms], scar [-0.27; 0.0 (0.0-1.2) vs. 8.7 (0.0-19.1)%], and SSI [0.41; 10.7 (7.1-16.8) vs. 4.2 (2.9-5.5)], but not QRSd [-0.13; 155 (140-176) vs. 167 (155-177) ms]. TLVAT and SSI were highly accurate in identifying CRT response [area under the curve (AUC) > 0.80], followed by scar (AUC > 0.70). Total left-ventricular activation time (odds ratio = 0.91), scar (0.94), and SSI (1.29) were independent factors associated with effective CRT. Subjects with SSI >7.9% and TLVAT <91 ms all responded to CRT with a median ΔESV ≈ -50%, while low SSI and prolonged TLVAT were more common in non-responders (ΔESV ≈ -5%). CONCLUSION Electromechanical measurements are better associated with CRT response than conventional ECG variables. The absence of scar combined with high SSI and low TLVAT ensures effectiveness of CRT.
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Affiliation(s)
| | - Tomasz Jadczyk
- Corresponding author. Tel: +48 32 252 39 30; fax: +48 32 252 39 30. E-mail address:
| | - Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Giulio Conte
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Maria Luce Caputo
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Krzysztof S Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Jolanta Biernat
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Magdalena Cybulska
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Guido Caluori
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, University of Bordeaux & INSERM, U 1045,Cardiothoracic Research Center of Bordeaux, Pessac, France
| | - François Regoli
- Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland,Cardiology Service, Ospedale Regionale di Bellinzona e Valli, Bellinzona, Switzerland
| | - Rolf Krause
- Center for Computational Medicine in Cardiology, Università della Svizzera Italiana, Lugano, Switzerland,Euler institute, Università della Svizzera Italiana, Lugano, Switzerland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Frits W Prinzen
- Department of Physiology, CARIM, Maastricht University, Maastricht, The Netherlands
| | - Angelo Auricchio
- Center for Computational Medicine in Cardiology, Università della Svizzera Italiana, Lugano, Switzerland,Division of Cardiology, Istituto Cardiocentro Ticino, Lugano, Switzerland
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Christoph J, Lebert J. Inverse mechano-electrical reconstruction of cardiac excitation wave patterns from mechanical deformation using deep learning. CHAOS (WOODBURY, N.Y.) 2020; 30:123134. [PMID: 33380038 DOI: 10.1063/5.0023751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/18/2020] [Indexed: 06/12/2023]
Abstract
The inverse mechano-electrical problem in cardiac electrophysiology is the attempt to reconstruct electrical excitation or action potential wave patterns from the heart's mechanical deformation that occurs in response to electrical excitation. Because heart muscle cells contract upon electrical excitation due to the excitation-contraction coupling mechanism, the resulting deformation of the heart should reflect macroscopic action potential wave phenomena. However, whether the relationship between macroscopic electrical and mechanical phenomena is well-defined and unique enough to be utilized for an inverse imaging technique in which mechanical activation mapping is used as a surrogate for electrical mapping has yet to be determined. Here, we provide a numerical proof-of-principle that deep learning can be used to solve the inverse mechano-electrical problem in phenomenological two- and three-dimensional computer simulations of the contracting heart wall, or in elastic excitable media, with muscle fiber anisotropy. We trained a convolutional autoencoder neural network to learn the complex relationship between electrical excitation, active stress, and tissue deformation during both focal or reentrant chaotic wave activity and, consequently, used the network to successfully estimate or reconstruct electrical excitation wave patterns from mechanical deformation in sheets and bulk-shaped tissues, even in the presence of noise and at low spatial resolutions. We demonstrate that even complicated three-dimensional electrical excitation wave phenomena, such as scroll waves and their vortex filaments, can be computed with very high reconstruction accuracies of about 95% from mechanical deformation using autoencoder neural networks, and we provide a comparison with results that were obtained previously with a physics- or knowledge-based approach.
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Affiliation(s)
- Jan Christoph
- Department of Cardiology and Pneumology, University Medical Center Göttingen, 37075 Göttingen, Germany
| | - Jan Lebert
- Department of Cardiology and Pneumology, University Medical Center Göttingen, 37075 Göttingen, Germany
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6
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Maffessanti F, Jadczyk T, Kurzelowski R, Regoli F, Caputo ML, Conte G, Gołba KS, Biernat J, Wilczek J, Dąbrowska M, Pezzuto S, Moccetti T, Krause R, Wojakowski W, Prinzen FW, Auricchio A. The influence of scar on the spatio-temporal relationship between electrical and mechanical activation in heart failure patients. Europace 2020; 22:777-786. [DOI: 10.1093/europace/euz346] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/05/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
The aim of this study was to determine the relationship between electrical and mechanical activation in heart failure (HF) patients and whether electromechanical coupling is affected by scar.
Methods and results
Seventy HF patients referred for cardiac resynchronization therapy or biological therapy underwent endocardial anatomo-electromechanical mapping (AEMM) and delayed-enhancement magnetic resonance (CMR) scans. Area strain and activation times were derived from AEMM data, allowing to correlate mechanical and electrical activation in time and space with unprecedented accuracy. Special attention was paid to the effect of presence of CMR-evidenced scar. Patients were divided into a scar (n = 43) and a non-scar group (n–27). Correlation between time of electrical and mechanical activation was stronger in the non-scar compared to the scar group [R = 0.84 (0.72–0.89) vs. 0.74 (0.52–0.88), respectively; P = 0.01]. The overlap between latest electrical and mechanical activation areas was larger in the absence than in presence of scar [72% (54–81) vs. 56% (36–73), respectively; P = 0.02], with smaller distance between the centroids of the two regions [10.7 (4.9–17.4) vs. 20.3 (6.9–29.4) % of left ventricular radius, P = 0.02].
Conclusion
Scar decreases the association between electrical and mechanical activation, even when scar is remote from late activated regions.
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Affiliation(s)
- Francesco Maffessanti
- Center for Computational Medicine in Cardiology, Università della Svizzera italiana, Via G. Buffi 13, CH-6900 Lugano, Switzerland
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne’s University Hospital Brno, Czech Republic
| | - Radosław Kurzelowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - François Regoli
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Maria Luce Caputo
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Giulio Conte
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Krzysztof S Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Jolanta Biernat
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Magdalena Dąbrowska
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Simone Pezzuto
- Center for Computational Medicine in Cardiology, Università della Svizzera italiana, Via G. Buffi 13, CH-6900 Lugano, Switzerland
| | - Tiziano Moccetti
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Rolf Krause
- Center for Computational Medicine in Cardiology, Università della Svizzera italiana, Via G. Buffi 13, CH-6900 Lugano, Switzerland
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
| | - Frits W Prinzen
- Department of Physiology, CARIM, Maastricht University, Maastricht, The Netherlands
| | - Angelo Auricchio
- Center for Computational Medicine in Cardiology, Università della Svizzera italiana, Via G. Buffi 13, CH-6900 Lugano, Switzerland
- Division of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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7
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Paton MF, Witte KK. Heart failure and right ventricular pacing - how to avoid the need for cardiac resynchronization therapy. Expert Rev Med Devices 2018; 16:35-43. [PMID: 30477355 DOI: 10.1080/17434440.2019.1552133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Heart failure (HF) is a common finding in patients with pacemakers implanted for bradycardia, with cross-sectional and longitudinal studies contributing to the growing consensus that right ventricular pacing can cause adverse cardiac remodeling and left ventricular systolic dysfunction increasing the risk of hospitalization and death. An unselected approach using cardiac resynchronization therapy from the time of first implant in patients with heart block has produced equivocal results. Contemporary research has therefore begun to focus on the stratification of patients' risk of pacemaker-associated impairment to permit focused, personalized management. AREAS COVERED The present review will describe the incidence and relevance of HF in the pacemaker population and discuss current management options for such patients. EXPERT COMMENTARY At present there are few contemporary data to guide the identification of patients with and at risk of pacemaker-associated cardiac remodeling and dysfunction. Emphasis must be placed on precise and personalized treatment approaches which currently remain under-investigated due to a number of challenges, for example, small sample sizes, limited clarity on programmed settings, and short follow-up periods.
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Affiliation(s)
- Maria F Paton
- a Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK
| | - Klaus K Witte
- a Leeds Institute of Cardiovascular and Metabolic Medicine , University of Leeds , Leeds , UK
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8
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Nguyên UC, Verzaal NJ, van Nieuwenhoven FA, Vernooy K, Prinzen FW. Pathobiology of cardiac dyssynchrony and resynchronization therapy. Europace 2018; 20:1898-1909. [DOI: 10.1093/europace/euy035] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 02/16/2018] [Indexed: 02/04/2023] Open
Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Nienke J Verzaal
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Frans A van Nieuwenhoven
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Universiteitssingel 50, ER Maastricht, The Netherlands
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9
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Huntjens PR, Ploux S, Strik M, Walmsley J, Ritter P, Haissaguerre M, Prinzen FW, Delhaas T, Lumens J, Bordachar P. Electrical Substrates Driving Response to Cardiac Resynchronization Therapy. Circ Arrhythm Electrophysiol 2018; 11:e005647. [DOI: 10.1161/circep.117.005647] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/22/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Peter R. Huntjens
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Sylvain Ploux
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Marc Strik
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - John Walmsley
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Philippe Ritter
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Michel Haissaguerre
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Frits W. Prinzen
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Tammo Delhaas
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Joost Lumens
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
| | - Pierre Bordachar
- Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.)
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10
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Characterizing left ventricular mechanical and electrical activation in patients with normal and impaired systolic function using a non-fluoroscopic cardiovascular navigation system. J Interv Card Electrophysiol 2018; 51:205-214. [PMID: 29388068 DOI: 10.1007/s10840-018-0317-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 01/22/2018] [Indexed: 10/18/2022]
Abstract
PURPOSE Cardiac disease frequently has a degenerative effect on cardiac pump function and regional myocardial contraction. Therefore, an accurate assessment of regional wall motion is a measure of the extent and severity of the disease. We sought to further validate an intra-operative, sensor-based technology for measuring wall motion and strain by characterizing left ventricular (LV) mechanical and electrical activation patterns in patients with normal (NSF) and impaired systolic function (ISF). METHODS NSF (n = 10; ejection fraction = 62.9 ± 6.1%) and ISF (n = 18; ejection fraction = 35.1 ± 13.6%) patients underwent simultaneous electrical and motion mapping of the LV endocardium using electroanatomical mapping and navigational systems (EnSite™ NavX™ and MediGuide™, Abbott). Motion trajectories, strain profiles, and activation times were calculated over the six standard LV walls. RESULTS NSF patients had significantly greater motion and systolic strains across all LV walls than ISF patients. LV walls with low-voltage areas showed less motion and systolic strain than walls with normal voltage. LV electrical dyssynchrony was significantly smaller in NSF and ISF patients with narrow-QRS complexes than ISF patients with wide-QRS complexes, but mechanical dyssynchrony was larger in all ISF patients than NSF patients. The latest mechanical activation was most often the lateral/posterior walls in NSF and wide-QRS ISF patients but varied in narrow-QRS ISF patients. CONCLUSIONS This intra-operative technique can be used to characterize LV wall motion and strain in patients with impaired systolic function. This technique may be utilized clinically to provide individually tailored LV lead positioning at the region of latest mechanical activation for patients undergoing cardiac resynchronization therapy. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov . Unique identifier: NCT01629160.
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Maffessanti F, Prinzen FW, Conte G, Regoli F, Caputo ML, Suerder D, Moccetti T, Faletra F, Krause R, Auricchio A. Integrated Assessment of Left Ventricular Electrical Activation and Myocardial Strain Mapping in Heart Failure Patients. JACC Clin Electrophysiol 2018; 4:138-146. [DOI: 10.1016/j.jacep.2017.08.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/25/2017] [Accepted: 08/17/2017] [Indexed: 01/04/2023]
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12
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Mechano-electrical feedback in the clinical setting: Current perspectives. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2017; 130:365-375. [DOI: 10.1016/j.pbiomolbio.2017.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 12/13/2022]
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13
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Auricchio A, Prinzen FW. Enhancing Response in the Cardiac Resynchronization Therapy Patient. JACC Clin Electrophysiol 2017; 3:1203-1219. [DOI: 10.1016/j.jacep.2017.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/02/2017] [Accepted: 08/10/2017] [Indexed: 12/17/2022]
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14
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Mafi-Rad M, van‘t Sant J, Blaauw Y, Doevendans PA, Cramer MJ, Crijns HJ, Prinzen FW, Meine M, Vernooy K. Regional Left Ventricular Electrical Activation and Peak Contraction Are Closely Related in Candidates for Cardiac Resynchronization Therapy. JACC Clin Electrophysiol 2017; 3:854-862. [DOI: 10.1016/j.jacep.2017.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 02/28/2017] [Accepted: 03/13/2017] [Indexed: 11/28/2022]
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15
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Ventricular dyssynchrony assessment using ultra-high frequency ECG technique. J Interv Card Electrophysiol 2017; 49:245-254. [PMID: 28695377 PMCID: PMC5543201 DOI: 10.1007/s10840-017-0268-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 06/20/2017] [Indexed: 11/17/2022]
Abstract
Purpose The aim of this proof-of-concept study is to introduce new high-dynamic ECG technique with potential to detect temporal-spatial distribution of ventricular electrical depolarization and to assess the level of ventricular dyssynchrony. Methods 5-kHz 12-lead ECG data was collected. The amplitude envelopes of the QRS were computed in an ultra-high frequency band of 500–1000 Hz and were averaged (UHFQRS). UHFQRS V lead maps were compiled, and numerical descriptor identifying ventricular dyssynchrony (UHFDYS) was detected. Results An electrical UHFQRS maps describe the ventricular dyssynchrony distribution in resolution of milliseconds and correlate with strain rate results obtained by speckle tracking echocardiography. The effect of biventricular stimulation is demonstrated by the UHFQRS morphology and by the UHFDYS descriptor in selected examples. Conclusions UHFQRS offers a new and simple technique for assessing electrical activation patterns in ventricular dyssynchrony with a temporal-spatial resolution that cannot be obtained by processing standard surface ECG. The main clinical potential of UHFQRS lies in the identification of differences in electrical activation among CRT candidates and detection of improvements in electrical synchrony in patients with biventricular pacing. Electronic supplementary material The online version of this article (doi:10.1007/s10840-017-0268-0) contains supplementary material, which is available to authorized users.
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Nguyên UC, Maffessanti F, Mafi-Rad M, Conte G, Zeemering S, Regoli F, Caputo ML, van Stipdonk AMW, Bekkers SCAM, Suerder D, Moccetti T, Krause R, Prinzen FW, Vernooy K, Auricchio A. Evaluation of the use of unipolar voltage amplitudes for detection of myocardial scar assessed by cardiac magnetic resonance imaging in heart failure patients. PLoS One 2017; 12:e0180637. [PMID: 28678875 PMCID: PMC5498065 DOI: 10.1371/journal.pone.0180637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 06/19/2017] [Indexed: 11/23/2022] Open
Abstract
Background Validation of voltage-based scar delineation has been limited to small populations using mainly endocardial measurements. The aim of this study is to compare unipolar voltage amplitudes (UnipV) with scar on delayed enhancement cardiac magnetic resonance imaging (DE-CMR). Methods Heart failure patients who underwent DE-CMR and electro-anatomic mapping were included. Thirty-three endocardial mapped patients and 27 epicardial mapped patients were investigated. UnipV were computed peak-to-peak. Electrograms were matched with scar extent of the corresponding DE-CMR segment using a 16-segment/slice model. Non-scar was defined as 0% scar, while scar was defined as 1–100% scar extent. Results UnipVs were moderately lower in scar than in non-scar (endocardial 7.1 [4.6–10.6] vs. 10.3 [7.4–14.2] mV; epicardial 6.7 [3.6–10.5] vs. 7.8 [4.2–12.3] mV; both p<0.001). The correlation between UnipV and scar extent was moderate for endocardial (R = -0.33, p<0.001), and poor for epicardial measurements (R = -0.07, p<0.001). Endocardial UnipV predicted segments with >25%, >50% and >75% scar extent with AUCs of 0.72, 0.73 and 0.76, respectively, while epicardial UnipV were poor scar predictors, independent of scar burden (AUC = 0.47–0.56). UnipV in non-scar varied widely between patients (p<0.001) and were lower in scar compared to non-scar in only 9/22 (41%) endocardial mapped patients and 4/19 (21%) epicardial mapped patients with scar. Conclusion UnipV are slightly lower in scar compared to non-scar. However, significant UnipV differences between and within patients and large overlap between non-scar and scar limits the reliability of accurate scar assessment, especially in epicardial measurements and in segments with less than 75% scar extent.
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Affiliation(s)
- Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
- * E-mail:
| | - Francesco Maffessanti
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
| | - Masih Mafi-Rad
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Giulio Conte
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Stef Zeemering
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - François Regoli
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Maria Luce Caputo
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | | | | | - Daniel Suerder
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Tiziano Moccetti
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
| | - Rolf Krause
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
| | - Frits W. Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
| | - Kevin Vernooy
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Angelo Auricchio
- Center for Computational Medicine in Cardiology, Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland
- Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland
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Derval N, Duchateau J, Mahida S, Eschalier R, Sacher F, Lumens J, Cochet H, Denis A, Pillois X, Yamashita S, Komatsu Y, Ploux S, Amraoui S, Zemmoura A, Ritter P, Hocini M, Haissaguerre M, Jaïs P, Bordachar P. Distinctive Left Ventricular Activations Associated With ECG Pattern in Heart Failure Patients. Circ Arrhythm Electrophysiol 2017. [DOI: 10.1161/circep.117.005073] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
In contrast to patients with left bundle branch block (LBBB), heart failure patients with narrow QRS and nonspecific intraventricular conduction delay (NICD) display a relatively limited response to cardiac resynchronization therapy. We sought to compare left ventricular (LV) activation patterns in heart failure patients with narrow QRS and NICD to patients with LBBB using high-density electroanatomic activation maps.
Methods and Results—
Fifty-two heart failure patients (narrow QRS [n=18], LBBB [n=11], NICD [n=23]) underwent 3-dimensional electroanatomic mapping with a high density of mapping points (387±349 LV). Adjunctive scar imaging was available in 37 (71%) patients and was analyzed in relation to activation maps. LBBB patients typically demonstrated (1) a single LV breakthrough at the septum (38±15 ms post-QRS onset); (2) prolonged right-to-left transseptal activation with absence of direct LV Purkinje activity; (3) homogeneous propagation within the LV cavity; and (4) latest activation at the basal lateral LV. In comparison, both NICD and narrow QRS patients demonstrated (1) multiple LV breakthroughs along the posterior or anterior fascicles: narrow QRS versus LBBB, 5±2 versus 1±1;
P
=0.0004; NICD versus LBBB, 4±2 versus 1±1;
P
=0.001); (2) evidence of early/pre-QRS LV electrograms with Purkinje potentials; (3) rapid propagation in narrow QRS patients and more heterogeneous propagation in NICD patients; and (4) presence of limited areas of late activation associated with LV scar with high interindividual heterogeneity.
Conclusions—
In contrast to LBBB patients, narrow QRS and NICD patients are characterized by distinct mechanisms of LV activation, which may predict poor response to cardiac resynchronization therapy.
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Affiliation(s)
- Nicolas Derval
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Josselin Duchateau
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Saagar Mahida
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Romain Eschalier
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Frederic Sacher
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Joost Lumens
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Hubert Cochet
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Arnaud Denis
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Xavier Pillois
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Seigo Yamashita
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Yuki Komatsu
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Sylvain Ploux
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Sana Amraoui
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Adlane Zemmoura
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Philippe Ritter
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Mélèze Hocini
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Michel Haissaguerre
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Pierre Jaïs
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
| | - Pierre Bordachar
- From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L’Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.)
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Chouchoulis K, Chiladakis J, Koutsogiannis N, Davlouros P, Kaza M, Alexopoulos D. Impact of QT interval prolongation following antiarrhythmic drug therapy on left ventricular function. Future Cardiol 2016; 13:13-22. [PMID: 27990843 DOI: 10.2217/fca-2016-0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We assessed whether antiarrhythmic drug-induced QT interval prolongation affects left ventricular function. METHODS Study population included 54 patients with symptomatic recent onset atrial fibrillation spontaneously cardioverted to sinus rhythm. Electrocardiographic and echocardiographic studies were done before initiating and after achieving drug's steady state. RESULTS Significantly prolonged corrected QT interval (QTc) was noticed following only sotalol and amiodarone. The corrected precontraction time increased after sotalol (p = 0.005) and amiodarone (p = 0.017), not propafenone (p = 0.139). Analysis results between ΔEF and ΔQTc, ΔEF and ΔQTc(p), ΔE/e' and ΔQTc, ΔE/e' and ΔQTc(p) for amiodarone group were (p = 0.66, p = 0.20, p = 0.66, p = 0.33), for sotalol (p = 0.36, p = 0.51, p = 0.44, p = 0.33) and for propafenone (p = 0.38, p = 0.12, p = 0.89, p = 0.61), respectively. CONCLUSION QT interval prolongation following antiarrhythmic therapy does not affect significantly left ventricular function.
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Affiliation(s)
| | - John Chiladakis
- Cardiology Department, University Hospital of Patras, Rion, Patras, Greece
| | | | - Periklis Davlouros
- Cardiology Department, University Hospital of Patras, Rion, Patras, Greece
| | - Maria Kaza
- School of Medicine, University of Patras, Rion, Patras, Greece
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Bunting E, Lambrakos L, Kemper P, Whang W, Garan H, Konofagou E. Imaging the Propagation of the Electromechanical Wave in Heart Failure Patients with Cardiac Resynchronization Therapy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 40:35-45. [PMID: 27790723 DOI: 10.1111/pace.12964] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 09/12/2016] [Accepted: 10/11/2016] [Indexed: 01/06/2023]
Abstract
BACKGROUND Current electrocardiographic and echocardiographic measurements in heart failure (HF) do not take into account the complex interplay between electrical activation and local wall motion. The utilization of novel technologies to better characterize cardiac electromechanical behavior may lead to improved response rates with cardiac resynchronization therapy (CRT). Electromechanical wave imaging (EWI) is a noninvasive ultrasound-based technique that uses the transient deformations of the myocardium to track the intrinsic EW that precedes myocardial contraction. In this paper, we investigate the performance and reproducibility of EWI in the assessment of HF patients and CRT. METHODS EWI acquisitions were obtained in five healthy controls and 16 HF patients with and without CRT pacing. Responders (n = 8) and nonresponders (n = 8) to CRT were identified retrospectively on the basis of left ventricular (LV) reverse remodeling. Electromechanical activation maps were obtained in all patients and used to compute a quantitative parameter describing the mean LV lateral wall activation time (LWAT). RESULTS Mean LWAT was increased by 52.1 ms in HF patients in native rhythm compared to controls (P < 0.01). For all HF patients, CRT pacing initiated a different electromechanical activation sequence. Responders exhibited a 56.4-ms ± 28.9-ms reduction in LWAT with CRT pacing (P < 0.01), while nonresponders showed no significant change. CONCLUSION In this initial feasibility study, EWI was capable of characterizing local cardiac electromechanical behavior as it pertains to HF and CRT response. Activation sequences obtained with EWI allow for quantification of LV lateral wall electromechanical activation, thus providing a novel method for CRT assessment.
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Affiliation(s)
- Ethan Bunting
- Department of Biomedical Engineering, Columbia University, New York, New York
| | - Litsa Lambrakos
- Division of Cardiology, Columbia University, New York, New York
| | - Paul Kemper
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - William Whang
- Division of Cardiology, Columbia University, New York, New York
| | - Hasan Garan
- Division of Cardiology, Columbia University, New York, New York
| | - Elisa Konofagou
- Department of Biomedical Engineering, Department of Radiology, Columbia University, New York, New York
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20
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Dawoud F, Schuleri KH, Spragg DD, Horáček BM, Berger RD, Halperin HR, Lardo AC. Insights from Novel Noninvasive CT and ECG Imaging Modalities on Electromechanical Myocardial Activation in a Canine Model of Ischemic Dyssynchronous Heart Failure. J Cardiovasc Electrophysiol 2016; 27:1454-1461. [PMID: 27578532 DOI: 10.1111/jce.13091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 08/12/2016] [Accepted: 08/17/2016] [Indexed: 01/26/2023]
Abstract
INTRODUCTION The interplay between electrical activation and mechanical contraction patterns is hypothesized to be central to reduced effectiveness of cardiac resynchronization therapy (CRT). Furthermore, complex scar substrates render CRT less effective. We used novel cardiac computed tomography (CT) and noninvasive electrocardiographic imaging (ECGI) techniques in an ischemic dyssynchronous heart failure (DHF) animal model to evaluate electrical and mechanical coupling of cardiac function, tissue viability, and venous accessibility of target pacing regions. METHODS AND RESULTS Ischemic DHF was induced in 6 dogs using coronary occlusion, left bundle ablation and tachy RV pacing. Full body ECG was recorded during native rhythm followed by volumetric first-pass and delayed enhancement CT. Regional electrical activation were computed and overlaid with segmented venous anatomy and scar regions. Reconstructed electrical activation maps show consistency with LBBB starting on the RV and spreading in a "U-shaped" pattern to the LV. Previously reported lines of slow conduction are seen parallel to anterior or inferior interventricular grooves. Mechanical contraction showed large septal to lateral wall delay (80 ± 38 milliseconds vs. 123 ± 31 milliseconds, P = 0.0001). All animals showed electromechanical correlation except dog 5 with largest scar burden. Electromechanical decoupling was largest in basal lateral LV segments. CONCLUSION We demonstrated a promising application of CT in combination with ECGI to gain insight into electromechanical function in ischemic dyssynchronous heart failure that can provide useful information to study regional substrate of CRT candidates.
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Affiliation(s)
- Fady Dawoud
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Karl H Schuleri
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - David D Spragg
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - B Milan Horáček
- Department of Electrical and Computer Engineering, Dalhousie University, Halifax, NS, Canada
| | - Ronald D Berger
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Henry R Halperin
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Albert C Lardo
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
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21
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Grondin J, Costet A, Bunting E, Gambhir A, Garan H, Wan E, Konofagou EE. Validation of electromechanical wave imaging in a canine model during pacing and sinus rhythm. Heart Rhythm 2016; 13:2221-2227. [PMID: 27498277 DOI: 10.1016/j.hrthm.2016.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND Accurate determination of regional areas of arrhythmic triggers is of key interest to diagnose arrhythmias and optimize their treatment. Electromechanical wave imaging (EWI) is an ultrasound technique that can image the transient deformation in the myocardium after electrical activation and therefore has the potential to detect and characterize location of triggers of arrhythmias. OBJECTIVES The objectives of this study were to investigate the relationship between the electromechanical and the electrical activation of the left ventricular (LV) endocardial surface during epicardial and endocardial pacing and during sinus rhythm as well as to map the distribution of electromechanical delays. METHODS In this study, 6 canines were investigated. Two external electrodes were sutured onto the epicardial surface of the LV. A 64-electrode basket catheter was inserted through the apex of the LV. Ultrasound channel data were acquired at 2000 frames/s during epicardial and endocardial pacing and during sinus rhythm. Electromechanical and electrical activation maps were synchronously obtained from the ultrasound data and the basket catheter, respectively. RESULTS The mean correlation coefficient between electromechanical and electrical activation was 0.81 for epicardial anterior pacing, 0.79 for epicardial lateral pacing, 0.69 for endocardial pacing, and 0.56 for sinus rhythm. CONCLUSION The electromechanical activation sequence determined by EWI follows the electrical activation sequence and more specifically in the case of pacing. This finding is of key interest in the role that EWI can play in the detection of the anatomical source of arrhythmias and the planning of pacing therapies such as cardiovascular resynchronization therapy.
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Affiliation(s)
| | | | | | - Alok Gambhir
- Department of Medicine, College of Physicians and Surgeons
| | - Hasan Garan
- Department of Medicine, College of Physicians and Surgeons
| | - Elaine Wan
- Department of Medicine, College of Physicians and Surgeons
| | - Elisa E Konofagou
- Department of Biomedical Engineering; Department of Radiology, Columbia University, New York, New York.
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22
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Chen Z, Hanson B, Sohal M, Sammut E, Jackson T, Child N, Claridge S, Behar J, Niederer S, Gill J, Carr-White G, Razavi R, Rinaldi CA, Taggart P. Coupling of ventricular action potential duration and local strain patterns during reverse remodeling in responders and nonresponders to cardiac resynchronization therapy. Heart Rhythm 2016; 13:1898-904. [PMID: 27301781 DOI: 10.1016/j.hrthm.2016.06.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Indexed: 10/21/2022]
Abstract
BACKGROUND The high risk of ventricular arrhythmias in patients with heart failure remains despite the benefit of cardiac resynchronization therapy (CRT). An electromechanical interaction between regional myocardial strain patterns and the electrophysiological substrate is thought to be important. OBJECTIVE We investigated the in vivo relation between left ventricular activation recovery interval (ARI), as a surrogate measure of action potential duration (APD), and local myocardial strain patterns in responders and nonresponders to CRT. METHODS ARIs were recorded from the left ventricular epicardium in 20 patients with CRT 6 weeks and 6 months post implantation. Two-dimensional speckle tracking echocardiography was performed at the same time to assess myocardial strains. Patients with ≥15% reduction in end-systolic volume at 6 months were classified as responders. RESULTS ARI decreased in responders (263 ± 46 ms vs 246 ± 47 ms, P < .01) and increased in nonresponders (235 ± 23 ms vs 261 ± 20 ms; P < .01). Time-to-peak radial, circumferential, and longitudinal strains increased in responders (41 ± 27, 35 ± 25, 56 ± 37 ms; P < .01) and decreased in nonresponders (-58 ± 26, -47 ± 26, -64 ± 27 ms; P < .01). There was a nonlinear correlation between changes in time-to-peak strain and ARIs (Spearman correlation coefficient r ≥ 0.70; P < .01). Baseline QRS duration >145 ms and QRS duration shortening with biventricular pacing were associated with ARI shortening following CRT. CONCLUSION Changes in ventricular wall mechanics predict local APD lengthening or shortening during CRT. Nonresponders have a worsening of myocardial strain and local APD. Baseline QRS duration >145 ms and QRS duration shortening with biventricular pacing identified patients who exhibited improvement in APD.
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Affiliation(s)
- Zhong Chen
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom,.
| | - Ben Hanson
- University College London, London, United Kingdom
| | - Manav Sohal
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Eva Sammut
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Tom Jackson
- King's College London, London, United Kingdom
| | - Nicholas Child
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Simon Claridge
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Jonathan Behar
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | | | - Jaswinder Gill
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Gerald Carr-White
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - Reza Razavi
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
| | - C Aldo Rinaldi
- King's College London, London, United Kingdom; Guy's and St Thomas' NHS Trust, London, United Kingdom
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23
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Dawoud F, Spragg DD, Berger RD, Cheng A, Horáček BM, Halperin HR, Lardo AC. Non-invasive electromechanical activation imaging as a tool to study left ventricular dyssynchronous patients: Implication for CRT therapy. J Electrocardiol 2016; 49:375-82. [PMID: 26968312 DOI: 10.1016/j.jelectrocard.2016.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Indexed: 10/22/2022]
Abstract
AIMS Electromechanical de-coupling is hypothesized to explain non-response of dyssynchrony patient to cardiac resynchronization therapy (CRT). In this pilot study, we investigated regional electromechanical uncoupling in 10 patients referred for CRT using two non-invasive electrical and mechanical imaging techniques (CMR tissue tracking and ECGI). METHODS AND RESULTS Reconstructed regional electrical and mechanical activation captured delayed LBBB propagation direction from septal to anterior/inferior and finally to lateral walls as well as from LV apical to basal. All 5 responders demonstrated significantly delayed mechanical and electrical activation on the lateral LV wall at baseline compared to the non-responders (P<.05). On follow-up ECGI, baseline electrical activation patterns were preserved in native rhythm and global LV activation time was reduced with biventricular pacing. CONCLUSIONS The combination of novel imaging techniques of ECGI and CMR tissue tracking can be used to assess spatial concordance of LV electrical and mechanical activation to gain insight into electromechanical coupling.
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Affiliation(s)
- Fady Dawoud
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
| | - David D Spragg
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Ronald D Berger
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Alan Cheng
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - B Milan Horáček
- Department of Electrical and Computer Engineering, Dalhousie University, Halifax, NS, Canada
| | - Henry R Halperin
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Albert C Lardo
- Division of Cardiology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
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24
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Abstract
The genesis of cardiac resynchronisation therapy (CRT) consists of 'bedside' research and 'bench' studies that are performed in series with each other. In this field, the bench studies are crucial for understanding the pathophysiology of dyssynchrony and resynchronisation. In a way, CRT started with the insight that abnormal ventricular conduction, as caused by right ventricular pacing, has adverse effects. Out of this research came the ground-breaking insight that 'simple' disturbances in impulse conduction, which were initially considered innocent, proved to result in a host of molecular and cellular derangements that lead to a vicious circle of remodelling processes that facilitate the development of heart failure. As a consequence, CRT does not only correct conduction abnormalities, but also improves myocardial properties at many levels. Interestingly, corrections by CRT do not exactly reverse the derangements, induced by dyssynchrony, but also activate novel pathways, a property that may open new avenues for the treatment of heart failure.
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Affiliation(s)
- R F Wiegerinck
- Department of Physiology, Cardiovascular Research Institute Maastricht, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - R Schreurs
- Department of Physiology, Cardiovascular Research Institute Maastricht, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - F W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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