Nicolas Derval1, Josselin Duchateau2, Saagar Mahida2, Romain Eschalier2, Frederic Sacher2, Joost Lumens2, Hubert Cochet2, Arnaud Denis2, Xavier Pillois2, Seigo Yamashita2, Yuki Komatsu2, Sylvain Ploux2, Sana Amraoui2, Adlane Zemmoura2, Philippe Ritter2, Mélèze Hocini2, Michel Haissaguerre2, Pierre Jaïs2, Pierre Bordachar2. 1. From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.). dervalnicolas@gmail.com. 2. From the Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, France (N.D., J.D., F.S., J.L., H.C., A.D., X.P., S.Y., Y.K., S.P., S.A., A.Z., P.R., M. Hocini, M. Haissaguerre, P.J., P.B.); Liverpool Heart and Chest Hospital, Liverpool, United Kingdom (S.M.); CHU Clermont-Ferrand, Clermont-Ferrand, France (R.E.); and Maastricht University Medical Center, The Netherlands (J.L.).
Abstract
BACKGROUND: In contrast to patients with left bundle branch block (LBBB), heart failure patients with narrow QRS and nonspecific intraventricular conduction delay (NICD) display a relatively limited response to cardiac resynchronization therapy. We sought to compare left ventricular (LV) activation patterns in heart failure patients with narrow QRS and NICD to patients with LBBB using high-density electroanatomic activation maps. METHODS AND RESULTS: Fifty-two heart failure patients (narrow QRS [n=18], LBBB [n=11], NICD [n=23]) underwent 3-dimensional electroanatomic mapping with a high density of mapping points (387±349 LV). Adjunctive scar imaging was available in 37 (71%) patients and was analyzed in relation to activation maps. LBBB patients typically demonstrated (1) a single LV breakthrough at the septum (38±15 ms post-QRS onset); (2) prolonged right-to-left transseptal activation with absence of direct LV Purkinje activity; (3) homogeneous propagation within the LV cavity; and (4) latest activation at the basal lateral LV. In comparison, both NICD and narrow QRS patients demonstrated (1) multiple LV breakthroughs along the posterior or anterior fascicles: narrow QRS versus LBBB, 5±2 versus 1±1; P=0.0004; NICD versus LBBB, 4±2 versus 1±1; P=0.001); (2) evidence of early/pre-QRS LV electrograms with Purkinje potentials; (3) rapid propagation in narrow QRS patients and more heterogeneous propagation in NICD patients; and (4) presence of limited areas of late activation associated with LV scar with high interindividual heterogeneity. CONCLUSIONS: In contrast to LBBB patients, narrow QRS and NICD patients are characterized by distinct mechanisms of LV activation, which may predict poor response to cardiac resynchronization therapy.
BACKGROUND: In contrast to patients with left bundle branch block (LBBB), heart failurepatients with narrow QRS and nonspecific intraventricular conduction delay (NICD) display a relatively limited response to cardiac resynchronization therapy. We sought to compare left ventricular (LV) activation patterns in heart failurepatients with narrow QRS and NICD to patients with LBBB using high-density electroanatomic activation maps. METHODS AND RESULTS: Fifty-two heart failurepatients (narrow QRS [n=18], LBBB [n=11], NICD [n=23]) underwent 3-dimensional electroanatomic mapping with a high density of mapping points (387±349 LV). Adjunctive scar imaging was available in 37 (71%) patients and was analyzed in relation to activation maps. LBBB patients typically demonstrated (1) a single LV breakthrough at the septum (38±15 ms post-QRS onset); (2) prolonged right-to-left transseptal activation with absence of direct LV Purkinje activity; (3) homogeneous propagation within the LV cavity; and (4) latest activation at the basal lateral LV. In comparison, both NICD and narrow QRS patients demonstrated (1) multiple LV breakthroughs along the posterior or anterior fascicles: narrow QRS versus LBBB, 5±2 versus 1±1; P=0.0004; NICD versus LBBB, 4±2 versus 1±1; P=0.001); (2) evidence of early/pre-QRS LV electrograms with Purkinje potentials; (3) rapid propagation in narrow QRS patients and more heterogeneous propagation in NICD patients; and (4) presence of limited areas of late activation associated with LV scar with high interindividual heterogeneity. CONCLUSIONS: In contrast to LBBB patients, narrow QRS and NICD patients are characterized by distinct mechanisms of LV activation, which may predict poor response to cardiac resynchronization therapy.
Authors: Mohammed A Ghossein; Antonius Mw van Stipdonk; Frits W Prinzen; Kevin Vernooy Journal: J Geriatr Cardiol Date: 2022-01-28 Impact factor: 3.327
Authors: Pavel Jurak; Laura R Bear; Uyên Châu Nguyên; Ivo Viscor; Petr Andrla; Filip Plesinger; Josef Halamek; Vlastimil Vondra; Emma Abell; Matthijs J M Cluitmans; Rémi Dubois; Karol Curila; Pavel Leinveber; Frits W Prinzen Journal: Sci Rep Date: 2021-06-01 Impact factor: 4.379