Detailed analysis of ventricular activation sequences during right ventricular apical pacing and left bundle branch block and the potential implications for cardiac resynchronization therapy
Detailed analysis of ventricular activation sequences during right ventricular apical pacing and left bundle branch block and the potential implications for cardiac resynchronization therapy
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DOI：
10.1016/j.hrthm.2014.09.059
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发表时间：
2015-01-01
期刊：
影响因子：
5.5
通讯作者：
Bordachar, Pierre
中科院分区：
文献类型：
--
作者：
Eschalier, Romain;Ploux, Sylvain;Bordachar, Pierre
背景左束支传导阻滞（LBBB）导致左心室（LV）总激活时间（TAT）和心室电解耦（VEU；平均左心室激活时间减去平均右心室[RV]激活时间）延长；两者均已被证明是心脏再同步治疗（CRT）的优先目标。右心室心尖起搏 (RVAP) 是否产生相似的心室激动模式尚未得到充分研究。 目的 本研究的目的是比较 RVAP 和 LBBB 期间的心室电激动模式。 方法 我们对 24 名 LBBB 患者在窦性心律、RVAP 和 CRT 期间进行心电图绘制。 结果 我们观察到 RVAP 与 LBBB 患者的电激动模式存在差异。 LBBB 期间，RV 激活迅速发生；相反，RVAP 期间 RV 激活时间延长（46 +/- 21 毫秒 vs 69 +/- 17 毫秒，P < .001）。 LVTAT无显着性差异；然而，观察到传导模式的差异。在 LBBB 期间，左心室激活是周向的，而在 RVAP 期间，左心室激活从心尖到基部进行。还观察到装载传导线的数量、大小和方向的差异。对于 LBBB，VEU 几乎是 RVAP 期间的两倍（73 +/- 12 毫秒 vs 38 +/- 21 毫秒，P < .001）。相对于 LBBB 激活，CRT 导致 VEU 更大程度地降低 (P < .001)。结论 与 LBBB 相比，RVAP 在心室激活特征方面产生显着差异。 RVAP 产生的 VEU 显着减少，因此 CRT 产生的 VEU 相对减少量较小。这可能解释了 CRT 对 LBBB 患者似乎比那些因 RV 起搏比例高而升级的患者更有效的发现。
BACKGROUND Left bundle branch block (LBBB) leads to prolonged left ventricular (LV) total activation time (TAT) and ventricular electrical uncoupling (VEU; mean LV activation time minus mean right ventricular [RV] activation time); both have been shown to be preferential targets for cardiac resynchronization therapy (CRT). Whether right ventricular apical pacing (RVAP) produces similar ventricular activation patterns has not been well studied.OBJECTIVE The purpose of this study was to compare electrical ventricular activation patterns during RVAP and LBBB.METHODS We performed ECG mapping during sinus rhythm, RVAP, and CRT in 24 patients with LBBB.RESULTS We observed differences in the electrical activation pattern with RVAP compared to LBBB. During LBBB, RV activation occurred rapidly; in contrast, RV activation was prolonged during RVAP (46 +/- 21 ms vs 69 +/- 17 ms, P < .001). There was no significant difference in LVTAT; however, differences in conduction pattern were observed. During LBBB, LV activation was circumferential, whereas with RVAP, LV activation proceeded from apex to base. Differences in the number, size, and orientation of lines of stow conduction also were observed. With LBBB, VEU was nearly twice as long as during RVAP (73 +/- 12 ms vs 38 +/- 21 ms, P < .001). CRT resulted in a greater reduction in VEU relative to LBBB activation (P < .001).CONCLUSION RVAP produces significant differences in ventricular activation characteristics compared to LBBB. Significantly less VEU occurs with RVAP, and as a result CRT produces a smaller relative reduction in VEU. This may explain the finding that CRT appears to be more effective in patients with LBBB than in those who were upgraded because of high percentages of RV pacing.