A different cardiac resynchronization therapy technique might be needed in some patients with nonspecific intraventricular conduction disturbance pattern
Gábor Katona1
Zsuzsanna Szelényi2
Gábor Szénási3
Bálint Kozman4
Zsolt Rekvényi4
Luca Kópházi1
Zsolt Dobos1
Szilvia Vereckei5
András Vereckei1
1.Department of Medicine and Hematology,Semmelweis University,Budapest,Hungary2.Heart and Vascular Center,Semmelweis University,Budapest,Hungary3.Institute of Translational Medicine,Semmelweis University,Budapest,Hungary4.Ardinsys Ltd.,Budapest,Hungary5.Budapest University of Technology and Economics,Faculty of Architecture,Budapest,Hungary
摘要：BACKGROUND Current cardiac resynchronization therapy (CRT), devised to eliminate dyssynchrony in left bundle branch block (LBBB), works by pacing the latest activated left ventricular site (LALVS). We hypothesized that patients with nonspecific intraventricular conduction disturbance (NICD) pattern respond less favorably to CRT, because their LALVS is far away from that in LBBB. METHODS By measuring the amplitude and polarity of secondary ST-segment alterations in two optional frontal and hori-zontal surface electrocardiogram (ECG) leads and using a software, we determined the resultant 3D spatial secondary ST vector, which is directed 180o away from the LALVS, in 110 patients with LBBB pattern and 77 patients with NICD pattern and heart failure. To validate the ECG method, we also estimated the LALVS by echocardiography using 3D parametric imaging and 2D speckle tracking in 22 LBBB patients and 20 NICD patients. Patients with NICD pattern were subdivided according to their non-overlapping frontal plane resultant secondary ST vector ranges to the NICD-1 subgroup (n = 44) and the NICD-2 subgroup (n = 33). RESULTS Based on the software determined coordinates of the resultant 3D spatial secondary ST vector directed 180o away from the LALVS, the LALVSs were located leftward, posterosuperior in the LBBB group, slightly left, superior in the NICD-1 sub-group, and slightly left, posteroinferior in the NICD-2 subgroup. The LALVS determined by ECG and echocardiography matched in all patients, except two. CONCLUSIONS In the NICD-2 subgroup, a remote LALVS was found from that in LBBB pattern, which might explain the high non-response rate of the NICD pattern to the current CRT technique.
机标关键词：synchronizationdisturbancedifferentraveavensomewithcardiac
论文发表日期：2021-12-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：11( 975-985 )