Three-dimensional mapping of optimal left ventricular pacing site for cardiac resynchronization
Three-dimensional mapping of optimal left ventricular pacing site for cardiac resynchronization
复制标题
DOI：
10.1161/circulationaha.106.643718
复制
发表时间：
2007-02-27
期刊：
影响因子：
37.8
通讯作者：
Lardo, Albert C.
中科院分区：
文献类型：
--
作者：
Helm, Robert H.;Byrne, Melissa;Lardo, Albert C.
背景-心脏起搏治疗（CRT）的有效性取决于左心室电极导线在晚激动区域内的位置。左心室（LV）的位置产生最佳CRT的地理范围和3维分布仍然unknow.Methods和结果-正常或tachypacing诱导失败的犬心脏不同步右心室游离壁起搏或慢性左冠状动脉分支消融急性仪表与非约束心外膜弹性袜子包含128个电极与计算机控制的刺激/记录系统。使用固定的右心室部位和覆盖整个游离壁的随机选择的LV部位进行双心室CRT。对于每个LV部位，确定整体心脏功能（电导导管）和机械同步性（磁共振成像标记），以产生反映CRT影响的三维标测图。最佳CRT是从左心室侧壁部位实现的，前壁比后壁略多，心尖比基底壁略多。产生>= 70%最大dP/dtmax增加的LV部位覆盖了约43%的LV游离壁。这种分布和大小在正常和衰竭的心脏中是相似的。该地区是相似的各种收缩和舒张参数和相关的三维地图的基础上，机械同步从磁共振成像应变analysis.Conclusions -在心脏延迟横向收缩，优化CRT是实现了一个相当广泛的区域LV侧壁在nonfailing和失败的心脏，适度的前或后偏差仍然能够提供有效的CRT。为实现最大机械同步性而选择的部位通常与最能改善整体功能的部位相似，这证实了使用室壁运动分析优化CRT的关键假设。
Background - The efficacy of cardiac resynchronization therapy (CRT) depends on placement of the left ventricular lead within the late-activated territory. The geographic extent and 3-dimensional distribution of left ventricular (LV) locations yielding optimal CRT remain unknown.Methods and Results - Normal or tachypacing-induced failing canine hearts made dyssynchronous by right ventricular free wall pacing or chronic left bundle-branch ablation were acutely instrumented with a nonconstraining epicardial elastic sock containing 128 electrodes interfaced with a computer-controlled stimulation/recording system. Biventricular CRT was performed using a fixed right ventricular site and randomly selected LV sites covering the entire free wall. For each LV site, global cardiac function (conductance catheter) and mechanical synchrony (magnetic resonance imaging tagging) were determined to yield 3-dimensional maps reflecting CRT impact. Optimal CRT was achieved from LV lateral wall sites, slightly more anterior than posterior and more apical than basal. LV sites yielding >= 70% of the maximal dP/dtmax increase covered approximate to 43% of the LV free wall. This distribution and size were similar in both normal and failing hearts. The region was similar for various systolic and diastolic parameters and correlated with 3-dimensional maps based on mechanical synchrony from magnetic resonance imaging strain analysis.Conclusions - In hearts with delayed lateral contraction, optimized CRT is achieved over a fairly broad area of LV lateral wall in both nonfailing and failing hearts, with modest anterior or posterior deviation still capable of providing effective CRT. Sites selected to achieve the most mechanical synchrony are generally similar to those that most improve global function, confirming a key assumption underlying the use of wall motion analysis to optimize CRT.