Document Detail


Electrical activation in the coronary sinus branches as a guide to cardiac resynchronisation therapy: rationale for a coordinate system.
MedLine Citation:
PMID:  21857896     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: For successful cardiac resynchronisation therapy (CRT) a spatial and electrical separation of right and left ventricular electrodes is essential. The spatial distribution of electrical delays within the coronary sinus (CS) tributaries has not yet been identified.
OBJECTIVE: Electrical delays within the CS are described during sinus rhythm (SR) and right ventricular pacing (RVP). A coordinate system grading the mitral ring from 0° to 360° and three vertical segments is proposed to define the lead positions irrespective of individual CS branch orientation.
METHODS: In 13 patients undergoing implantation of a CRT device 6±2.5, (median 5) lead positions within the CS were mapped during SR and RVP. The delay to the onset and the peak of the local signal was measured from the earliest QRS activation or the pacing spike. Fluoroscopic positions were compared to localizations on a nonfluoroscopic electrode imaging system.
RESULTS: During SR, electrical delays in the CS were inhomogenous in patients with or without left bundle branch block (LBBB). During RVP, the delays increased by 44±32 ms (signal onset from 36±33 ms to 95±30 ms; p<0.001, signal peak from 105±44 ms to 156±30 ms; p<0.001). The activation pattern during RVP was homogeneous and predictable by taking the grading on the CS ring into account: (% QRS) = 78-0.002 (grade-162)(2), p<0.0001. This indicates that 78% of the QRS duration can be expected as a maximum peak delay at 162° on the CS ring.
CONCLUSION: Electrical delays within the CS vary during SR, but prolong and become predictable during RVP. A coordinate system helps predicting the local delays and facilitates interindividual comparison of lead positions irrespective of CS branch anatomy.
Authors:
Christoph Scharf; Nazmi Krasniqi; Jens Hellermann; Mariette Rahn; Gabor Sütsch; Corinna Brunckhorst; Firat Duru
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Publication Detail:
Type:  Journal Article     Date:  2011-08-08
Journal Detail:
Title:  PloS one     Volume:  6     ISSN:  1932-6203     ISO Abbreviation:  PLoS ONE     Publication Date:  2011  
Date Detail:
Created Date:  2011-08-22     Completed Date:  2012-02-15     Revised Date:  2013-06-27    
Medline Journal Info:
Nlm Unique ID:  101285081     Medline TA:  PLoS One     Country:  United States    
Other Details:
Languages:  eng     Pagination:  e19914     Citation Subset:  IM    
Affiliation:
Division of Pacing and Electrophysiology, Clinic for Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland. christoph.scharf@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiac Resynchronization Therapy / methods*
Cardiac Resynchronization Therapy Devices
Coronary Sinus / pathology,  physiopathology*
Echocardiography
Follow-Up Studies
Heart Conduction System / physiopathology*,  ultrasonography
Humans
Male
Middle Aged
Treatment Outcome
Ventricular Dysfunction, Left / physiopathology,  therapy,  ultrasonography
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