open access

Vol 63, No 12 (2005)
Other
Published online: 2005-12-14
Submitted: 2012-12-28
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ORIGINAL ARTICLE
Ventricular activation patterns during different pacing modes. An insight from electroanatomical mapping

Petr Peichl, Josef Kautzner, Robert Cihák, Lucie Riedlbauchová, Jan Bytešník
Kardiol Pol 2005;63(12):622-632.

open access

Vol 63, No 12 (2005)
Other
Published online: 2005-12-14
Submitted: 2012-12-28

Abstract

Background: Biventricular pacing (BiV) is employed as the current standard for cardiac resynchronisation therapy. Other pacing modalities have been proposed as alternatives; however, data on changes in electrical activation sequence caused by pacing from various sites are limited. Aim: To describe changes in activation patterns during different ventricular pacing modes in patients with chronic heart failure. Methods: A total number of 20 patients (mean age 59.6±8years) with chronic heart failure, intraventricular conduction abnormality (QRS >130ms) or complete AV block were studied. Endocardial activation maps of both ventricles (CARTOTM, Biosense-Webster) were obtained during spontaneous rhythm and biventricular (BiV, n=9), right ventricular bifocal (BiF, n=7) and single-site left ventricular (LV, n=4) pacing. The following parameters were assessed: activation pattern, total LV endocardial activation time (LVAT) and electrical interventricular delay (IVD). Results: Right ventricular apical pacing was associated with the longest LVAT (145±24 ms). On the contrary, both BiV and BiF pacing shortened LVAT with BiV being superior in the degree of LVAT reduction (89±13 vs 103±10 ms, p<0.05). BiV pacing also significantly shortened IVD and modified the LV activation sequence in a complex manner. Such changes were not observed during BiF pacing. In the presence of fusion with spontaneous activation, single-site LV pacing was comparable to BiV pacing. Conclusions: Among the different pacing modes, BiV pacing and single-site LV pacing with fusion resulted in the most pronounced changes in ventricular activation that appear to be a prerequisite for successful resynchronization of both ventricles.

Abstract

Background: Biventricular pacing (BiV) is employed as the current standard for cardiac resynchronisation therapy. Other pacing modalities have been proposed as alternatives; however, data on changes in electrical activation sequence caused by pacing from various sites are limited. Aim: To describe changes in activation patterns during different ventricular pacing modes in patients with chronic heart failure. Methods: A total number of 20 patients (mean age 59.6±8years) with chronic heart failure, intraventricular conduction abnormality (QRS >130ms) or complete AV block were studied. Endocardial activation maps of both ventricles (CARTOTM, Biosense-Webster) were obtained during spontaneous rhythm and biventricular (BiV, n=9), right ventricular bifocal (BiF, n=7) and single-site left ventricular (LV, n=4) pacing. The following parameters were assessed: activation pattern, total LV endocardial activation time (LVAT) and electrical interventricular delay (IVD). Results: Right ventricular apical pacing was associated with the longest LVAT (145±24 ms). On the contrary, both BiV and BiF pacing shortened LVAT with BiV being superior in the degree of LVAT reduction (89±13 vs 103±10 ms, p<0.05). BiV pacing also significantly shortened IVD and modified the LV activation sequence in a complex manner. Such changes were not observed during BiF pacing. In the presence of fusion with spontaneous activation, single-site LV pacing was comparable to BiV pacing. Conclusions: Among the different pacing modes, BiV pacing and single-site LV pacing with fusion resulted in the most pronounced changes in ventricular activation that appear to be a prerequisite for successful resynchronization of both ventricles.
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Keywords

cardiac pacing; ventricular activation; electroanatomical mapping; cardiac resynchronisation therapy; chronic heart failure

About this article
Title

ORIGINAL ARTICLE
Ventricular activation patterns during different pacing modes. An insight from electroanatomical mapping

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 63, No 12 (2005)

Pages

622-632

Published online

2005-12-14

Bibliographic record

Kardiol Pol 2005;63(12):622-632.

Keywords

cardiac pacing
ventricular activation
electroanatomical mapping
cardiac resynchronisation therapy
chronic heart failure

Authors

Petr Peichl
Josef Kautzner
Robert Cihák
Lucie Riedlbauchová
Jan Bytešník

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