Cardiac electrical dyssynchrony is accurately detected by noninvasive electrocardiographic imaging
Cardiac electrical dyssynchrony is accurately detected by noninvasive electrocardiographic imaging
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DOI：
10.1016/j.hrthm.2018.02.024
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发表时间：
2018-07-01
期刊：
影响因子：
5.5
通讯作者：
Dubois, Remi
中科院分区：
文献类型：
--
作者：
Bear, Laura R.;Huntjens, Peter R.;Dubois, Remi
背景电不同步的识别能力差被认为是导致心脏起搏治疗成功率低的主要因素。目的本研究的目的是评估体表标测和心电图成像（ECG i）对无创检测电不同步的敏感性。方法Langendorff灌注的猪心（n = 11）悬浮在人躯干形水槽中，通过消融诱导左束支分支传导阻滞（LBBB）。在窦性心律和心室起搏期间，从108个电极的心外膜套和嵌入罐表面的128个电极同时进行记录。计算机断层扫描提供了电极和心脏在水箱中的位置。使用ECGi从躯干电位重建心外膜单极电图。来自躯干电位的不同步标记（例如，QRS持续时间）或ECGi（总激动时间、室间延迟[D-LR]和心室内标记物）与从袜子记录的那些相关。和sock导出的激动标测图显示了室间不同步（D-LR和总激动时间）（P <0.05）和完全LBBB的心室内不同步（P <0.05）与正常窦性心律相比。只有D-LR在双心室起搏后恢复正常（P = .1）。躯干标记物随着大程度的不同步而增加，在双心室起搏期间没有观察到减少（P > 0.05）。尽管ECGI衍生的标记物显著低于记录值（P <0.05），但ECGI和记录值之间存在显著的强线性关系。所有病例的心电图均正确诊断了电不同步和室间性钙化。最新的激活部位被确定为9.1 ± 0.6 mm的ECGi.CONCLUSION ECGi可靠，准确地检测电不同步，双心室起搏，最新的激活部位，提供更多的信息比体表电位。
BACKGROUND Poor identification of electrical dyssynchrony is postulated to be a major factor contributing to the low success rate for cardiac resynchronization therapy.OBJECTIVE The purpose of this study was to evaluate the sensitivity of body surface mapping and electrocardiographic imaging (ECGi) to detect electrical dyssynchrony noninvasively.METHODS Langendorff-perfused pig hearts (n = 11) were suspended in a human torso-shaped tank, with left bundle branch block (LBBB) induced through ablation. Recordings were taken simultaneously from a 108-electrode epicardial sock and 128 electrodes embedded in the tank surface during sinus rhythm and ventricular pacing. Computed tomography provided electrode and heart positions in the tank. Epicardial unipolar electrograms were reconstructed from torso potentials using ECGi. Dyssynchrony markers from torso potentials (eg, QRS duration) or ECGi (total activation time, interventricular delay [D-LR], and intraventricular markers) were correlated with those recorded from the sock.RESULTS LBBB was induced (n = 8), and sock-derived activation maps demonstrated interventricular dyssynchrony (D-LR and total activation time) in all cases (P < .05) and intraventricular dyssynchrony for complete LBBB (P < .05) compared to normal sinus rhythm. Only D-LR returned to normal with biventricular pacing (P = .1). Torso markers increased with large degrees of dyssynchrony, and no reduction was seen during biventricular pacing (P > .05). Although ECGi-derived markers were significantly lower than recorded (P < .05), there was a significant strong linear relationship between ECGi and recorded values. ECGi correctly diagnosed electrical dyssynchrony and interventricular resynchronization in all cases. The latest site of activation was identified to 9.1 +/- 0.6 mm by ECGi.CONCLUSION ECGi reliably and accurately detects electrical dyssynchrony, resynchronization by biventricular pacing, and the site of latest activation, providing more information than do body surface potentials.