Coronary sinus activation patterns in patients with and without left bundle branch block undergoing electroanatomic mapping system-guided cardiac resynchronization therapy device implantation

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• 作者：Maurizio Del Greco ; MD ; FHRS^* ; ^{maurizio.delgreco@apss.tn.it} ; Alessandro Zorzi ; MD^* ; ^&dagger ; ; Irene Di Matteo ; MD^* ; Anna Cima ; MD^* ; Massimiliano Maines ; MD^* ; Carlo Angheben ; MD^* ; Domenico Catanzariti ; MD^*
• 关键词：Cardiac resynchronization therapy ; Electroanatomic mapping system ; Heart failure ; Implantable cardioverter-defibrillator ; Left bundle branch block
• 刊名：Heart Rhythm
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：14
• 期：2
• 页码：225-233
• 全文大小：4084 K
• 卷排序：14

文摘

Implantation of the left ventricular (LV) lead in segments with delayed electrical activation may improve response to cardiac resynchronization therapy (CRT).ObjectiveThe purpose of this study was to evaluate the amount and regional distribution of LV electrical delay (LVED) in patients with or without left bundle branch block (LBBB).MethodsWe enrolled 60 patients who underwent electroanatomic mapping system&ndash;guided CRT device implantation. Activation mapping of the coronary sinus (CS) branches was performed using an insulated guidewire. LVED was defined as the interval between the beginning of the QRS complex on the surface electrocardiogram (ECG) and the local electrogram and expressed in milliseconds or as percentage of the total QRS duration (LVED%).ResultsForty-three patients showed a LBBB and 17 a non-LBBB electrocardiographic pattern. A total of 148 CS branches (mean 2.5 per patient; range 2&ndash;4 per patient) were mapped. Patients with LBBB showed higher maximum LVED (135 ms [108&ndash;150 ms] vs 100 ms [103&ndash;110 ms]; P < .001) and LVED% (86% [79%&ndash;89%] vs 72% [54%&ndash;80%]; P < .001) than did patients without LBBB. The maximum LVED was recorded in mid-basal anterolateral or inferolateral LV segments (traditional CRT targets), significantly more often in patients with LBBB than in patients without LBBB (85% vs 59%; P = .02). The number of CS branches showing LVED >50% of the total QRS duration, >75% of the total QRS duration, and >85 ms was significantly higher in patients with LBBB than in patients without LBBB.ConclusionPatients without LBBB showed lower LVED and more heterogeneous electrical activation of the CS than did patients with LBBB. This finding may contribute to a lower rate of response to CRT of patients without LBBB and suggests the use of activation mapping to guide LV lead placement.