A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: an in vivo and in silico study.
- Nguyên UC Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), PO Box 616, Maastricht MD, the Netherlands.
- Potse M CARMEN Research Team, Inria Bordeaux Sud-Ouest, Talence F-33400, France.
- Vernooy K Department of Cardiology, CARIM, MUMC+, Maastricht, the Netherlands.
- Mafi-Rad M Department of Cardiology, CARIM, MUMC+, Maastricht, the Netherlands.
- Heijman J Department of Cardiology, CARIM, MUMC+, Maastricht, the Netherlands.
- Caputo ML Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
- Conte G Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
- Regoli F Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
- Krause R Center for Computational Medicine in Cardiology (CCMC), Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland.
- Moccetti T Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
- Auricchio A Department of Cardiology, Fondazione Cardiocentro Ticino, Lugano, Switzerland.
- Prinzen FW Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), PO Box 616, Maastricht MD, the Netherlands.
- Maffessanti F Center for Computational Medicine in Cardiology (CCMC), Institute of Computational Science, Università della Svizzera italiana, Lugano, Switzerland.
- 2018-11-27
Published in:
- Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - 2018
Action Potentials
Adult
Aged
Aged, 80 and over
Bundle of His
Bundle-Branch Block
Cardiac Pacing, Artificial
Computer Simulation
Electrocardiography
Electrophysiologic Techniques, Cardiac
Female
Heart Rate
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Models, Cardiovascular
Time Factors
Treatment Outcome
Ventricular Function, Left
Ventricular Function, Right
English
Aims
The aim of this study was to investigate the influence of the activation sequence on voltage amplitudes by evaluating regional voltage differences during a left bundle branch block (LBBB) activation sequence vs. a normal synchronous activation sequence and by evaluating pacing-induced voltage differences.
Methods and results
Twenty-one patients and three computer models without scar were studied. Regional voltage amplitudes were evaluated in nine LBBB patients who underwent endocardial electro-anatomic mapping (EAM). Pacing-induced voltage differences were evaluated in 12 patients who underwent epicardial EAM during intrinsic rhythm and right ventricular (RV) pacing. Three computer models customized for LBBB patients were created. Changes in voltage amplitudes after an LBBB (intrinsic), a normal synchronous, an RV pacing, and a left ventricular pacing activation sequence were assessed in the computer models. Unipolar voltage amplitudes in patients were approximately 4.5 mV (4.4-4.7 mV, ∼33%) lower in the septum when compared with other segments. A normal synchronous activation sequence in the computer models normalized voltage amplitudes in the septum. Pacing-induced differences were larger in electrograms with higher voltage amplitudes during intrinsic rhythm and furthermore larger and more variable at the epicardium [mean absolute difference: 3.6-6.2 mV, 40-53% of intrinsic value; interquartile range (IQR) differences: 53-63% of intrinsic value] compared to the endocardium (mean absolute difference: 3.3-3.8 mV, 28-30% of intrinsic value; IQR differences: 37-40% of intrinsic value).
Conclusion
In patients and computer models without scar, lower septal unipolar voltage amplitudes are exclusively associated with an LBBB activation sequence. Pacing substantially affects voltage amplitudes, particularly at the epicardium.
The aim of this study was to investigate the influence of the activation sequence on voltage amplitudes by evaluating regional voltage differences during a left bundle branch block (LBBB) activation sequence vs. a normal synchronous activation sequence and by evaluating pacing-induced voltage differences.
Methods and results
Twenty-one patients and three computer models without scar were studied. Regional voltage amplitudes were evaluated in nine LBBB patients who underwent endocardial electro-anatomic mapping (EAM). Pacing-induced voltage differences were evaluated in 12 patients who underwent epicardial EAM during intrinsic rhythm and right ventricular (RV) pacing. Three computer models customized for LBBB patients were created. Changes in voltage amplitudes after an LBBB (intrinsic), a normal synchronous, an RV pacing, and a left ventricular pacing activation sequence were assessed in the computer models. Unipolar voltage amplitudes in patients were approximately 4.5 mV (4.4-4.7 mV, ∼33%) lower in the septum when compared with other segments. A normal synchronous activation sequence in the computer models normalized voltage amplitudes in the septum. Pacing-induced differences were larger in electrograms with higher voltage amplitudes during intrinsic rhythm and furthermore larger and more variable at the epicardium [mean absolute difference: 3.6-6.2 mV, 40-53% of intrinsic value; interquartile range (IQR) differences: 53-63% of intrinsic value] compared to the endocardium (mean absolute difference: 3.3-3.8 mV, 28-30% of intrinsic value; IQR differences: 37-40% of intrinsic value).
Conclusion
In patients and computer models without scar, lower septal unipolar voltage amplitudes are exclusively associated with an LBBB activation sequence. Pacing substantially affects voltage amplitudes, particularly at the epicardium.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1093/europace/euy233
- PMID 30476054
- Persistent URL
- https://sonar.ch/global/documents/139661
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