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Curila K, Poviser L, Stros P, Jurak P, Whinnett Z, Jastrzebski M, Waldauf P, Smisek R, Viscor I, Hozman M, Osmancik P, Kryze L, Kautzner J. LVSP and LBBP Result in Similar or Improved LV Synchrony and Hemodynamics Compared to BVP. JACC Clin Electrophysiol 2024:S2405-500X(24)00348-7. [PMID: 38829298 DOI: 10.1016/j.jacep.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND The effect of left ventricular septal myocardial pacing (LVSP) and left bundle branch pacing (LBBP) on ventricular synchrony and left ventricular (LV) hemodynamic status is poorly understood. OBJECTIVES The aim of this study was to investigate the impact of LVSP and LBBP vs biventricular pacing (BVP) on ventricular electrical synchrony and hemodynamic status in cardiac resynchronization therapy patients. METHODS In cardiac resynchronization therapy candidates with LV conduction disease, ventricular synchrony was assessed by measuring QRS duration (QRSd) and using ultra-high-frequency electrocardiography. LV electrical dyssynchrony was assessed as the difference between the first activation in leads V1 to V8 to the last from leads V4 to V8. LV hemodynamic status was estimated using invasive systolic blood pressure measurement during multiple transitions between LBBP, LVSP, and BVP. RESULTS A total of 35 patients with a mean LV ejection fraction of 29% and a mean QRSd of 168 ± 24 ms were included. Thirteen had ischemic cardiomyopathy. QRSd during BVP, LVSP, and LBBP was the same, but LBBP provided shorter LV electrical dyssynchrony than BVP (-10 ms; 95% CI: -16 to -4 ms; P = 0.001); the difference between LVSP and BVP was not significant (-5 ms; 95% CI: -12 to 1 ms; P = 0.10). LBBP was associated with higher systolic blood pressure than BVP (4%; 95% CI: 2% to 5%; P < 0.001), whereas LVSP was not (1%; 95% CI: 0% to 2%; P = 0.10). Hemodynamic differences during LBBP and LVSP vs BVP were more pronounced in nonischemic than ischemic patients. CONCLUSIONS Ultra-high-frequency electrocardiography allowed the documentation of differences in LV synchrony between LBBP, LVSP, and BVP, which were not observed by measuring QRSd. LVSP provided the same LV synchrony and hemodynamic status as BVP, while LBBP was better than BVP in both.
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Affiliation(s)
- Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Lukas Poviser
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Stros
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, Czech Republic
| | - Zachary Whinnett
- Department of Cardiology, National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Petr Waldauf
- Department of Anesthesia and Intensive Care, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Radovan Smisek
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, Czech Republic
| | - Ivo Viscor
- Institute of Scientific Instruments, Czech Academy of Sciences, Brno, Czech Republic
| | - Marek Hozman
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Lukas Kryze
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Kautzner
- Institute of Clinical and Experimental Medicine, Prague, Czech Republic
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Verstappen AAA, Hautvast R, Jurak P, Bracke FA, Rademakers LM. Ventricular dyssynchrony imaging, echocardiographic and clinical outcomes of left bundle branch pacing and biventricular pacing. Indian Pacing Electrophysiol J 2024; 24:140-146. [PMID: 38657736 PMCID: PMC11143746 DOI: 10.1016/j.ipej.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 04/10/2024] [Accepted: 04/22/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Left bundle branch pacing (LBBP) is a novel physiological pacing technique which may serve as an alternative to cardiac resynchronization therapy (CRT) by biventricular pacing (BVP). This study assessed ventricular activation patterns and echocardiographic and clinical outcomes of LBBP and compared this to BVP. METHODS Fifty consecutive patients underwent LBBP or BVP for CRT. Ventricular activation mapping was obtained by ultra-high-frequency ECG (UHF-ECG). Functional and echocardiographic outcomes and hospitalization for heart failure and all-cause mortality after one year from implantation were evaluated. RESULTS LBBP resulted in greater resynchronization vs BVP (QRS width: 170 ± 16 ms to 128 ± 20 ms vs 174 ± 15 to 144 ± 17 ms, p = 0.002 (LBBP vs BVP); e-DYS 81 ± 17 ms to 0 ± 32 ms vs 77 ± 18 to 16 ± 29 ms, p = 0.016 (LBBP vs BVP)). Improvement in LVEF (from 28 ± 8 to 42 ± 10 percent vs 28 ± 9 to 36 ± 12 percent, LBBP vs BVP, p = 0.078) was similar. Improvement in NYHA function class (from 2.4 to 1.5 and from 2.3 to 1.5 (LBBP vs BVP)), hospitalization for heart failure and all-cause mortality were comparable in both groups. CONCLUSIONS Ventricular dyssynchrony imaging is an appropriate way to gain a better insight into activation patterns of LBBP and BVP. LBBP resulted in greater resynchronization (e-DYS and QRS duration) with comparable improvement in LVEF, NYHA functional class, hospitalization for heart failure and all-cause mortality at one year of follow up.
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Affiliation(s)
| | - Rick Hautvast
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
| | - Pavel Jurak
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czech Republic
| | - Frank A Bracke
- Department of Cardiology, Catharina Hospital, Eindhoven, the Netherlands
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Leinveber P, Halamek J, Curila K, Prinzen F, Lipoldova J, Matejkova M, Smisek R, Plesinger F, Nagy A, Novak M, Viscor I, Vondra V, Jurak P. Ultra-high-frequency ECG volumetric and negative derivative epicardial ventricular electrical activation pattern. Sci Rep 2024; 14:5681. [PMID: 38454102 PMCID: PMC10920693 DOI: 10.1038/s41598-024-55789-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 02/27/2024] [Indexed: 03/09/2024] Open
Abstract
From precordial ECG leads, the conventional determination of the negative derivative of the QRS complex (ND-ECG) assesses epicardial activation. Recently we showed that ultra-high-frequency electrocardiography (UHF-ECG) determines the activation of a larger volume of the ventricular wall. We aimed to combine these two methods to investigate the potential of volumetric and epicardial ventricular activation assessment and thereby determine the transmural activation sequence. We retrospectively analyzed 390 ECG records divided into three groups-healthy subjects with normal ECG, left bundle branch block (LBBB), and right bundle branch block (RBBB) patients. Then we created UHF-ECG and ND-ECG-derived depolarization maps and computed interventricular electrical dyssynchrony. Characteristic spatio-temporal differences were found between the volumetric UHF-ECG activation patterns and epicardial ND-ECG in the Normal, LBBB, and RBBB groups, despite the overall high correlations between both methods. Interventricular electrical dyssynchrony values assessed by the ND-ECG were consistently larger than values computed by the UHF-ECG method. Noninvasively obtained UHF-ECG and ND-ECG analyses describe different ventricular dyssynchrony and the general course of ventricular depolarization. Combining both methods based on standard 12-lead ECG electrode positions allows for a more detailed analysis of volumetric and epicardial ventricular electrical activation, including the assessment of the depolarization wave direction propagation in ventricles.
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Affiliation(s)
- Pavel Leinveber
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic.
| | - Josef Halamek
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Frits Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Jolana Lipoldova
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- First Department of Internal Medicine and Cardioangiology, St. Anne's University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Magdalena Matejkova
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Radovan Smisek
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czech Republic
| | - Filip Plesinger
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Andrej Nagy
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- First Department of Internal Medicine and Cardioangiology, St. Anne's University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Miroslav Novak
- International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
- First Department of Internal Medicine and Cardioangiology, St. Anne's University Hospital Brno, Brno, Czech Republic
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ivo Viscor
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Vlastimil Vondra
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
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Curila K, Jurak P, Varma N. Resynchronization for shifting conduction patterns - When a coronary sinus lead is not enough. Indian Pacing Electrophysiol J 2023; 23:214-215. [PMID: 37598754 PMCID: PMC10685094 DOI: 10.1016/j.ipej.2023.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 04/04/2023] [Accepted: 08/17/2023] [Indexed: 08/22/2023] Open
Affiliation(s)
- Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Pavel Jurak
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA
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Simon A, Pilecky D, Kiss LZ, Vamos M. Useful Electrocardiographic Signs to Support the Prediction of Favorable Response to Cardiac Resynchronization Therapy. J Cardiovasc Dev Dis 2023; 10:425. [PMID: 37887872 PMCID: PMC10607456 DOI: 10.3390/jcdd10100425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Cardiac resynchronization therapy (CRT) is a cornerstone therapeutic opportunity for selected patients with heart failure. For optimal patient selection, no other method has been proven to be more effective than the 12-lead ECG, and hence ECG characteristics are extensively researched. The evaluation of particular ECG signs before the implantation may improve selection and, consequently, clinical outcomes. The definition of a true left bundle branch block (LBBB) seems to be the best starting point with which to select patients for CRT. Although there are no universally accepted definitions of LBBB, using the classical LBBB criteria, some ECG parameters are associated with CRT response. In patients with non-true LBBB or non-LBBB, further ECG predictors of response and non-response could be analyzed, such as QRS fractionation, signs of residual left bundle branch conduction, S-waves in V6, intrinsicoid deflection, or non-invasive estimates of Q-LV which are described in newer publications. The most important and recent study results of the topic are summarized and discussed in this current review.
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Affiliation(s)
- Andras Simon
- Department of Cardiology, Szent Imre University Teaching Hospital, 1115 Budapest, Hungary;
| | - David Pilecky
- Gottsegen National Cardiovascular Center, 1096 Budapest, Hungary;
- Doctoral School of Clinical Medicine, University of Szeged, 6725 Szeged, Hungary
| | | | - Mate Vamos
- Cardiac Electrophysiology Division, Department of Internal Medicine, University of Szeged, 6725 Szeged, Hungary
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Curila K, Vijayaraman P. Left ventricular resynchronization with left bundle branch area pacing: does the type of capture matter? Europace 2023; 25:euad152. [PMID: 37294670 PMCID: PMC10254070 DOI: 10.1093/europace/euad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023] Open
Affiliation(s)
- Karol Curila
- Cardiocenter, Third Faculty of Medicine and Faculty Hospital Kralovske Vinohrady, Prague, Czechia
| | - Pugazhendhi Vijayaraman
- Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, 1000 E Mountain Blvd, MC 36-10, Wilkes Barre, PA 18711, USA
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Sussenbek O, Rademakers L, Waldauf P, Jurak P, Smisek R, Stros P, Poviser L, Vesela J, Plesinger F, Halamek J, Leinveber P, Herman D, Osmancik P, Curila K. Left bundle branch area pacing results in more physiological ventricular activation than biventricular pacing in patients with left bundle branch block heart failure. Eur Heart J Suppl 2023; 25:E17-E24. [PMID: 37234235 PMCID: PMC10206755 DOI: 10.1093/eurheartjsupp/suad109] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Biventricular pacing (Biv) and left bundle branch area pacing (LBBAP) are methods of cardiac resynchronization therapy (CRT). Currently, little is known about how they differ in terms of ventricular activation. This study compared ventricular activation patterns in left bundle branch block (LBBB) heart failure patients using an ultra-high-frequency electrocardiography (UHF-ECG). This was a retrospective analysis including 80 CRT patients from two centres. UHF-ECG data were obtained during LBBB, LBBAP, and Biv. Left bundle branch area pacing patients were divided into non-selective left bundle branch pacing (NSLBBP) or left ventricular septal pacing (LVSP) and into groups with V6 R-wave peak times (V6RWPT) < 90 ms and ≥ 90 ms. Calculated parameters were: e-DYS (time difference between the first and last activation in V1-V8 leads) and Vdmean (average of V1-V8 local depolarization durations). In LBBB patients (n = 80) indicated for CRT, spontaneous rhythms were compared with Biv (39) and LBBAP rhythms (64). Although both Biv and LBBAP significantly reduced QRS duration (QRSd) compared with LBBB (from 172 to 148 and 152 ms, respectively, both P < 0.001), the difference between them was not significant (P = 0.2). Left bundle branch area pacing led to shorter e-DYS (24 ms) than Biv (33 ms; P = 0.008) and shorter Vdmean (53 vs. 59 ms; P = 0.003). No differences in QRSd, e-DYS, or Vdmean were found between NSLBBP, LVSP, and LBBAP with paced V6RWPTs < 90 and ≥ 90 ms. Both Biv CRT and LBBAP significantly reduce ventricular dyssynchrony in CRT patients with LBBB. Left bundle branch area pacing is associated with more physiological ventricular activation.
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Affiliation(s)
| | - Leonard Rademakers
- Department of Cardiology, Catharina Ziekenhuis, 5602 ZA Eindhoven, The Netherlands
| | - Petr Waldauf
- Department of Anesthesia and Intensive Care, Charles University, University Hospital Kralovske Vinohrady, Prague 10034, Czechia
| | - Pavel Jurak
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno 61200, Czechia
| | - Radovan Smisek
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno 61200, Czechia
| | - Petr Stros
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 1150/50, Praha 10, Prague 10034, Czechia
| | - Lukas Poviser
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 1150/50, Praha 10, Prague 10034, Czechia
| | - Jana Vesela
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 1150/50, Praha 10, Prague 10034, Czechia
| | - Filip Plesinger
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno 61200, Czechia
| | - Josef Halamek
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno 61200, Czechia
| | - Pavel Leinveber
- International Clinical Research Center, St. Anne’s University Hospital, Brno 60200, Czechia
| | - Dalibor Herman
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 1150/50, Praha 10, Prague 10034, Czechia
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Srobarova 1150/50, Praha 10, Prague 10034, Czechia
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Bressi E, Grieco D, Čurila K, Zanon F, Marcantoni L, Cabrera JA, De Ruvo E, Vernooy K, Calò L. Pacing of the specialized His-Purkinje conduction system: 'back to the future'. Eur Heart J Suppl 2023; 25:C234-C241. [PMID: 37125312 PMCID: PMC10132574 DOI: 10.1093/eurheartjsupp/suad047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
The conduction system of the human heart is composed of specialized cardiomyocytes that initiate and propagate the electric impulse with consequent rhythmic and synchronized contraction of the atria and ventricles, resulting in the normal cardiac cycle. Although the His-Purkinje system (HPS) was already described more than a century ago, there has been a recent resurgence of conduction system pacing (CSP), where pacing leads are positioned in the His bundle region and left bundle branch area to provide physiological cardiac activation as alternatives to the unnatural myocardial stimulation obtained with conventional right ventricular and biventricular pacing. In this review, we describe the fundamental anatomical and pathophysiological aspects of the specialized HPS along with the CSP technique's nuts and bolts to highlight its potential benefits in everyday clinical practice.
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Affiliation(s)
- Edoardo Bressi
- Corresponding author. Tel: +39 0 3297382095, Fax: 0623188408,
| | - Domenico Grieco
- Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Via Casilina, 1049, 00169 Rome, Italy
| | - Karol Čurila
- Department of Cardiology, Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Ruská 2411, 100 00 Prague 10-Vinohrady, Czech Republic
| | - Francesco Zanon
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Santa Maria della Misericordia General Hospital, Viale Tre Martiri, 140, 45100 Rovigo, Italy
| | - Lina Marcantoni
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Santa Maria della Misericordia General Hospital, Viale Tre Martiri, 140, 45100 Rovigo, Italy
| | - Jose Angel Cabrera
- Unidad de Arritmias, Departamento de Cardiología, Hospital Universitario Quirón-Salud Madrid and Complejo Hospitalario Ruber Juan Bravo, Universidad Europea de Madrid, Calle de Juan Bravo, 49, 28006 Madrid, Spain
| | - Ermenegildo De Ruvo
- Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Via Casilina, 1049, 00169 Rome, Italy
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Leonardo Calò
- Department of Cardiovascular Sciences, Policlinico Casilino of Rome, Via Casilina, 1049, 00169 Rome, Italy
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9
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Curila K, Jurak P, Prinzen F, Jastrzebski M, Waldauf P, Halamek J, Tothova M, Znojilova L, Smisek R, Kach J, Poviser L, Linkova H, Plesinger F, Moskal P, Viscor I, Vondra V, Leinveber P, Osmancik P. Bipolar anodal septal pacing with direct LBB capture preserves physiological ventricular activation better than unipolar left bundle branch pacing. Front Cardiovasc Med 2023; 10:1140988. [PMID: 37034324 PMCID: PMC10073552 DOI: 10.3389/fcvm.2023.1140988] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 02/23/2023] [Indexed: 04/11/2023] Open
Abstract
Background Left bundle branch pacing (LBBP) produces delayed, unphysiological activation of the right ventricle. Using ultra-high-frequency electrocardiography (UHF-ECG), we explored how bipolar anodal septal pacing with direct LBB capture (aLBBP) affects the resultant ventricular depolarization pattern. Methods In patients with bradycardia, His bundle pacing (HBP), unipolar nonselective LBBP (nsLBBP), aLBBP, and right ventricular septal pacing (RVSP) were performed. Timing of local ventricular activation, in leads V1-V8, was displayed using UHF-ECG, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. Durations of local depolarizations were determined as the width of the UHF-QRS complex at 50% of its amplitude. Results aLBBP was feasible in 63 of 75 consecutive patients with successful nsLBBP. aLBBP significantly improved ventricular dyssynchrony (mean -9 ms; 95% CI (-12;-6) vs. -24 ms (-27;-21), ), p < 0.001) and shortened local depolarization durations in V1-V4 (mean differences -7 ms to -5 ms (-11;-1), p < 0.05) compared to nsLBBP. aLBBP resulted in e-DYS -9 ms (-12; -6) vs. e-DYS 10 ms (7;14), p < 0.001 during HBP. Local depolarization durations in V1-V2 during aLBBP were longer than HBP (differences 5-9 ms (1;14), p < 0.05, with local depolarization duration in V1 during aLBBP being the same as during RVSP (difference 2 ms (-2;6), p = 0.52). Conclusion Although aLBBP improved ventricular synchrony and depolarization duration of the septum and RV compared to unipolar nsLBBP, the resultant ventricular depolarization was still less physiological than during HBP.
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Affiliation(s)
- Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
- Correspondence: Karol Curila
| | - Pavel Jurak
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Frits Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Petr Waldauf
- Department of Anesthesia and Intensive Care, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Josef Halamek
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Marketa Tothova
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Lucie Znojilova
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Radovan Smisek
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
- Faculty of Electrical Engineering and Communication, Department of Biomedical Engineering, Brno University of Technology, Brno, Czech Republic
| | - Jakub Kach
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Lukas Poviser
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Hana Linkova
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Filip Plesinger
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Pawel Moskal
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Ivo Viscor
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Vlastimil Vondra
- Institute of Scientific Instruments, The Czech Academy of Sciences, Brno, Czech Republic
| | - Pavel Leinveber
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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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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11
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Kong NW, Upadhyay GA. Cardiac resynchronization considerations in left bundle branch block. Front Physiol 2022; 13:962042. [PMID: 36187776 PMCID: PMC9520457 DOI: 10.3389/fphys.2022.962042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/30/2022] [Indexed: 11/18/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) via biventricular pacing (BiVP) is an established treatment for patients with left ventricular systolic heart failure and intraventricular conduction delay resulting in wide QRS. Seminal trials demonstrating mortality benefit from CRT were conducted in patients with wide left bundle branch block (LBBB) pattern on electrocardiogram (ECG) and evidence of clinical heart failure. The presence of conduction block was assumed to correlate with commonly applied criteria for LBBB. More recent data has challenged this assertion, revealing that LBBB pattern may include distinct underlying pathophysiology, including patients with complete conduction block, either at the left-sided His fibers or the proximal left bundle, intact Purkinje activation with wide LBBB-like QRS, and patients demonstrating both proximal block and distal delay. Currently, BiVP-CRT is indicated for all QRS duration ≥150 ms and may be considered for BBB patterns from 130 to 149 ms with robust clinical data to support its use. Despite this, however, there remains a significant number of non-responders to BVP. Conduction system pacing (CSP) has emerged as an alternative approach to deliver CRT and correct QRS in patients with conduction block. Newer hybrid approaches which combine CSP and traditional BiVP-CRT and may hold promise for patients with IP or mixed-level block. As various approaches to CRT continue to be studied, physiologic phenotyping of the LBBB pattern remains an important consideration.
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Affiliation(s)
- Nathan W. Kong
- Department of Internal Medicine, University of Chicago Medicine, Chicago, IL, United States
| | - Gaurav A. Upadhyay
- Section of Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, IL, United States
- *Correspondence: Gaurav A. Upadhyay,
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12
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Mizner J, Jurak P, Linkova H, Smisek R, Curila K. Ventricular Dyssynchrony and Pacing-induced Cardiomyopathy in Patients with Pacemakers, the Utility of Ultra-high-frequency ECG and Other Dyssynchrony Assessment Tools. Arrhythm Electrophysiol Rev 2022; 11:e17. [PMID: 35990106 PMCID: PMC9376832 DOI: 10.15420/aer.2022.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022] Open
Abstract
The majority of patients tolerate right ventricular pacing well; however, some patients manifest signs of heart failure after pacemaker implantation and develop pacing-induced cardiomyopathy. This is a consequence of non-physiological ventricular activation bypassing the conduction system. Ventricular dyssynchrony was identified as one of the main factors responsible for pacing-induced cardiomyopathy development. Currently, methods that would allow rapid and reliable ventricular dyssynchrony assessment, ideally during the implant procedure, are lacking. Paced QRS duration is an imperfect marker of dyssynchrony, and methods based on body surface mapping, electrocardiographic imaging or echocardiography are laborious and time-consuming, and can be difficult to use during the implantation procedure. However, the ventricular activation sequence can be readily displayed from the chest leads using an ultra-high-frequency ECG. It can be performed during the implantation procedure to visualise ventricular depolarisation and resultant ventricular dyssynchrony during pacing. This information can assist the electrophysiologist in selecting a pacing location that avoids dyssynchronous ventricular activation.
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Affiliation(s)
- Jan Mizner
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Hana Linkova
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Radovan Smisek
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Karol Curila
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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13
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Treger JS, Upadhyay GA. What Intracardiac Tracings Have Taught Us About Left Bundle Branch Block. Card Electrophysiol Clin 2022; 14:203-211. [PMID: 35715078 DOI: 10.1016/j.ccep.2021.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Current electrocardiogram (ECG) criteria for left bundle branch block (LBBB) are largely based on early work in animal models or on mathematical models of cardiac activation. The resulting criteria have modest specificity, and up to one-third of patients who meet current ECG criteria for LBBB may have intact conduction through their His-Purkinje systems. Intracardiac tracings offer the ability to accurately discriminate between LBBB and other causes of delayed activation, which may facilitate the development of more accurate ECG criteria. Assessing these distinctions are particularly salient to applications for conduction system pacing.
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Affiliation(s)
- Jeremy S Treger
- The University of Chicago Medicine, Center for Arrhythmia Care, Heart and Vascular Center, Chicago, IL, USA
| | - Gaurav A Upadhyay
- The University of Chicago Medicine, Center for Arrhythmia Care, Heart and Vascular Center, Chicago, IL, USA.
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14
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Stracina T, Ronzhina M, Redina R, Novakova M. Golden Standard or Obsolete Method? Review of ECG Applications in Clinical and Experimental Context. Front Physiol 2022; 13:867033. [PMID: 35547589 PMCID: PMC9082936 DOI: 10.3389/fphys.2022.867033] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022] Open
Abstract
Cardiovascular system and its functions under both physiological and pathophysiological conditions have been studied for centuries. One of the most important steps in the cardiovascular research was the possibility to record cardiac electrical activity. Since then, numerous modifications and improvements have been introduced; however, an electrocardiogram still represents a golden standard in this field. This paper overviews possibilities of ECG recordings in research and clinical practice, deals with advantages and disadvantages of various approaches, and summarizes possibilities of advanced data analysis. Special emphasis is given to state-of-the-art deep learning techniques intensely expanded in a wide range of clinical applications and offering promising prospects in experimental branches. Since, according to the World Health Organization, cardiovascular diseases are the main cause of death worldwide, studying electrical activity of the heart is still of high importance for both experimental and clinical cardiology.
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Affiliation(s)
- Tibor Stracina
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marina Ronzhina
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czech Republic
| | - Richard Redina
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czech Republic.,International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czech Republic
| | - Marie Novakova
- Department of Physiology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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15
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Curila K, Jurak P, Vernooy K, Jastrzebski M, Waldauf P, Prinzen F, Halamek J, Susankova M, Znojilova L, Smisek R, Karch J, Plesinger F, Moskal P, Heckman L, Mizner J, Viscor I, Vondra V, Leinveber P, Osmancik P. Left Ventricular Myocardial Septal Pacing in Close Proximity to LBB Does Not Prolong the Duration of the Left Ventricular Lateral Wall Depolarization Compared to LBB Pacing. Front Cardiovasc Med 2021; 8:787414. [PMID: 34950718 PMCID: PMC8688808 DOI: 10.3389/fcvm.2021.787414] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Three different ventricular capture types are observed during left bundle branch pacing (LBBp). They are selective LBB pacing (sLBBp), non-selective LBB pacing (nsLBBp), and myocardial left septal pacing transiting from nsLBBp while decreasing the pacing output (LVSP). Study aimed to compare differences in ventricular depolarization between these captures using ultra-high-frequency electrocardiography (UHF-ECG). Methods: Using decremental pacing voltage output, we identified and studied nsLBBp, sLBBp, and LVSP in patients with bradycardia. Timing of ventricular activations in precordial leads was displayed using UHF-ECGs, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. The durations of local depolarizations (Vd) were determined as the width of the UHF-QRS complex at 50% of its amplitude. Results: In 57 consecutive patients, data were collected during nsLBBp (n = 57), LVSP (n = 34), and sLBBp (n = 23). Interventricular dyssynchrony (e-DYS) was significantly lower during LVSP −16 ms (−21; −11), than nsLBBp −24 ms (−28; −20) and sLBBp −31 ms (−36; −25). LVSP had the same V1d-V8d as nsLBBp and sLBBp except for V3d, which during LVSP was shorter than sLBBp; the mean difference −9 ms (−16; −1), p = 0.01. LVSP caused less interventricular dyssynchrony and the same or better local depolarization durations than nsLBBp and sLBBp irrespective of QRS morphology during spontaneous rhythm or paced QRS axis. Conclusions: In patients with bradycardia, LVSP in close proximity to LBB resulted in better interventricular synchrony than nsLBBp and sLBBp and did not significantly prolong depolarization of the left ventricular lateral wall.
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Affiliation(s)
- Karol Curila
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Pavel Jurak
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Marek Jastrzebski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Petr Waldauf
- Department of Anesthesia and Intensive Care, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Frits Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Josef Halamek
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Marketa Susankova
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Lucie Znojilova
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Radovan Smisek
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia.,Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication, Brno University of Technology, Brno, Czechia
| | - Jakub Karch
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Filip Plesinger
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Pawel Moskal
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University, Medical College, Krakow, Poland
| | - Luuk Heckman
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Jan Mizner
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
| | - Ivo Viscor
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Vlastimil Vondra
- The Czech Academy of Sciences, Institute of Scientific Instruments, Brno, Czechia
| | - Pavel Leinveber
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czechia
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Prague, Czechia
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16
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Sedova K, Repin K, Donin G, Dam PV, Kautzner J. Clinical Utility of Body Surface Potential Mapping in CRT Patients. Arrhythm Electrophysiol Rev 2021; 10:113-119. [PMID: 34401184 PMCID: PMC8335851 DOI: 10.15420/aer.2021.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
This paper reviews the current status of the knowledge on body surface potential mapping (BSPM) and ECG imaging (ECGI) methods for patient selection, left ventricular (LV) lead positioning, and optimisation of CRT programming, to indicate the major trends and future perspectives for the application of these methods in CRT patients. A systematic literature review using PubMed, Scopus, and Web of Science was conducted to evaluate the available clinical evidence regarding the usage of BSPM and ECGI methods in CRT patients. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement was used as a basis for this review. BSPM and ECGI methods applied in CRT patients were assessed, and quantitative parameters of ventricular depolarisation delivered from BSPM and ECGI were extracted and summarised. BSPM and ECGI methods can be used in CRT in several ways, namely in predicting CRT outcome, in individualised optimisation of CRT device programming, and the guiding of LV electrode placement, however, further prospective or randomised trials are necessary to verify the utility of BSPM for routine clinical practice.
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Affiliation(s)
- Ksenia Sedova
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Kirill Repin
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Gleb Donin
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Peter Van Dam
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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17
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Jurak P, Bear LR, Nguyên UC, Viscor I, Andrla P, Plesinger F, Halamek J, Vondra V, Abell E, Cluitmans MJM, Dubois R, Curila K, Leinveber P, Prinzen FW. 3-Dimensional ventricular electrical activation pattern assessed from a novel high-frequency electrocardiographic imaging technique: principles and clinical importance. Sci Rep 2021; 11:11469. [PMID: 34075135 PMCID: PMC8169848 DOI: 10.1038/s41598-021-90963-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/19/2021] [Indexed: 11/29/2022] Open
Abstract
The study introduces and validates a novel high-frequency (100–400 Hz bandwidth, 2 kHz sampling frequency) electrocardiographic imaging (HFECGI) technique that measures intramural ventricular electrical activation. Ex-vivo experiments and clinical measurements were employed. Ex-vivo, two pig hearts were suspended in a human-torso shaped tank using surface tank electrodes, epicardial electrode sock, and plunge electrodes. We compared conventional epicardial electrocardiographic imaging (ECGI) with intramural activation by HFECGI and verified with sock and plunge electrodes. Clinical importance of HFECGI measurements was performed on 14 patients with variable conduction abnormalities. From 3 × 4 needle and 108 sock electrodes, 256 torso or 184 body surface electrodes records, transmural activation times, sock epicardial activation times, ECGI-derived activation times, and high-frequency activation times were computed. The ex-vivo transmural measurements showed that HFECGI measures intramural electrical activation, and ECGI-HFECGI activation times differences indicate endo-to-epi or epi-to-endo conduction direction. HFECGI-derived volumetric dyssynchrony was significantly lower than epicardial ECGI dyssynchrony. HFECGI dyssynchrony was able to distinguish between intraventricular conduction disturbance and bundle branch block patients.
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Affiliation(s)
- Pavel Jurak
- Institute of Scientific Instruments, The Czech Academy of Sciences, Kralovopolska 147, Brno, 635 00, Czech Republic.
| | - Laura R Bear
- IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Univ. Bordeaux, CRCTB, U1045, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
| | - Uyên Châu Nguyên
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ivo Viscor
- Institute of Scientific Instruments, The Czech Academy of Sciences, Kralovopolska 147, Brno, 635 00, Czech Republic
| | - Petr Andrla
- Institute of Scientific Instruments, The Czech Academy of Sciences, Kralovopolska 147, Brno, 635 00, Czech Republic
| | - Filip Plesinger
- Institute of Scientific Instruments, The Czech Academy of Sciences, Kralovopolska 147, Brno, 635 00, Czech Republic
| | - Josef Halamek
- Institute of Scientific Instruments, The Czech Academy of Sciences, Kralovopolska 147, Brno, 635 00, Czech Republic
| | - Vlastimil Vondra
- Institute of Scientific Instruments, The Czech Academy of Sciences, Kralovopolska 147, Brno, 635 00, Czech Republic
| | - Emma Abell
- IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Univ. Bordeaux, CRCTB, U1045, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
| | - Matthijs J M Cluitmans
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rémi Dubois
- IHU Liryc, Fondation Bordeaux Université, Pessac-Bordeaux, France.,Univ. Bordeaux, CRCTB, U1045, Bordeaux, France.,INSERM, CRCTB, U1045, Bordeaux, France
| | - Karol Curila
- Cardiocenter, Department of Cardiology, 3rd Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pavel Leinveber
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
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18
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Left bundle branch pacing compared to left ventricular septal myocardial pacing increases interventricular dyssynchrony but accelerates left ventricular lateral wall depolarization. Heart Rhythm 2021; 18:1281-1289. [PMID: 33930549 DOI: 10.1016/j.hrthm.2021.04.025] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/11/2021] [Accepted: 04/22/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Nonselective His-bundle pacing (nsHBp), nonselective left bundle branch pacing (nsLBBp), and left ventricular septal myocardial pacing (LVSP) are recognized as physiological pacing techniques. OBJECTIVE The purpose of this study was to compare differences in ventricular depolarization between these techniques using ultra-high-frequency electrocardiography (UHF-ECG). METHODS In patients with bradycardia, nsHBp, nsLBBp (confirmed concomitant left bundle branch [LBB] and myocardial capture), and LVSP (pacing in left ventricular [LV] septal position without proven LBB capture) were performed. Timings of ventricular activations in precordial leads were displayed using UHF-ECG, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. Duration of local depolarization (Vd) was determined as width of the UHF-QRS complex at 50% of its amplitude. RESULTS In 68 patients, data were collected during nsLBBp (35), LVSP (96), and nsHBp (55). nsLBBp resulted in larger e-DYS than did LVSP and nsHBp [- 24 ms (-28;-19) vs -12 ms (-16;-9) vs 10 ms (7;14), respectively; P <.001]. nsLBBp produced similar values of Vd in leads V5-V8 (36-43 ms vs 38-43 ms; P = NS in all leads) but longer Vd in leads V1-V4 (47-59 ms vs 41-44 ms; P <.05) as nsHBp. LVSP caused prolonged Vd in leads V1-V8 compared to nsHBp and longer Vd in leads V5-V8 compared to nsLBBp (44-51 ms vs 36-43 ms; P <.05) regardless of R-wave peak time in lead V5 or QRS morphology in lead V1 present during LVSP. CONCLUSION nslbbp preserves physiological LV depolarization but increases interventricular electrical dyssynchrony. LV lateral wall depolarization during LVSP is prolonged, but interventricular synchrony is preserved.
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19
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Curila K, Jurak P, Halamek J, Prinzen F, Waldauf P, Karch J, Stros P, Plesinger F, Mizner J, Susankova M, Prochazkova R, Sussenbek O, Viscor I, Vondra V, Smisek R, Leinveber P, Osmancik P. Ventricular activation pattern assessment during right ventricular pacing: Ultra‐high‐frequency ECG study. J Cardiovasc Electrophysiol 2021; 32:1385-1394. [DOI: 10.1111/jce.14985] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Karol Curila
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Josef Halamek
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Frits Prinzen
- Department of Physiology Cardiovascular Research Institute Maastricht Maastricht the Netherlands
| | - Petr Waldauf
- Department of Anesthesia and Intensive Care Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Jakub Karch
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Petr Stros
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Filip Plesinger
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Jan Mizner
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Marketa Susankova
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Radka Prochazkova
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Ondrej Sussenbek
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
| | - Ivo Viscor
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Vlastimil Vondra
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
| | - Radovan Smisek
- Institute of Scientific Instruments, Czech Academy of Sciences Brno Czech Republic
- Department of Biomedical Engineering, Faculty of Electrical Engineering and Communication Brno University of Technology Brno Czech Republic
| | - Pavel Leinveber
- International Clinical Research Center St. Anne's University Hospital Brno Czech Republic
| | - Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic
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Comparing Ventricular Synchrony in Left Bundle Branch and Left Ventricular Septal Pacing in Pacemaker Patients. J Clin Med 2021; 10:jcm10040822. [PMID: 33671420 PMCID: PMC7923157 DOI: 10.3390/jcm10040822] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 12/21/2022] Open
Abstract
Background: Left bundle branch area pacing (LBBAP) has recently been introduced as a novel physiological pacing strategy. Within LBBAP, distinction is made between left bundle branch pacing (LBBP) and left ventricular septal pacing (LVSP, no left bundle capture). Objective: To investigate acute electrophysiological effects of LBBP and LVSP as compared to intrinsic ventricular conduction. Methods: Fifty patients with normal cardiac function and pacemaker indication for bradycardia underwent LBBAP. Electrocardiography (ECG) characteristics were evaluated during pacing at various depths within the septum: starting at the right ventricular (RV) side of the septum: the last position with QS morphology, the first position with r’ morphology, LVSP and—in patients where left bundle branch (LBB) capture was achieved—LBBP. From the ECG’s QRS duration and QRS morphology in lead V1, the stimulus- left ventricular activation time left ventricular activation time (LVAT) interval were measured. After conversion of the ECG into vectorcardiogram (VCG) (Kors conversion matrix), QRS area and QRS vector in transverse plane (Azimuth) were determined. Results: QRS area significantly decreased from 82 ± 29 µVs during RV septal pacing (RVSP) to 46 ± 12 µVs during LVSP. In the subgroup where LBB capture was achieved (n = 31), QRS area significantly decreased from 46 ± 17 µVs during LVSP to 38 ± 15 µVs during LBBP, while LVAT was not significantly different between LVSP and LBBP. In patients with normal ventricular activation and narrow QRS, QRS area during LBBP was not significantly different from that during intrinsic activation (37 ± 16 vs. 35 ± 19 µVs, respectively). The Azimuth significantly changed from RVSP (−46 ± 33°) to LVSP (19 ± 16°) and LBBP (−22 ± 14°). The Azimuth during both LVSP and LBBP were not significantly different from normal ventricular activation. QRS area and LVAT correlated moderately (Spearman’s R = 0.58). Conclusions: ECG and VCG indices demonstrate that both LVSP and LBBP improve ventricular dyssynchrony considerably as compared to RVSP, to values close to normal ventricular activation. LBBP seems to result in a small, but significant, improvement in ventricular synchrony as compared to LVSP.
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