Document Detail


Twenty-millisecond interventricular difference as assessed by body surface potential mapping identifies patients with clinical improvement after implantation of cardiac resynchronization device.
MedLine Citation:
PMID:  17584728     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: There is little research on the ventricular electrical aspects following cardiac resynchronization therapy (CRT). This study sought to establish electrocardiographic criteria associated to the ventricular electrical activation process that could identify patients with functional class (FC) improvement after CRT, by using the noninvasive method of body surface potential mapping (BSPM). METHODS: Fifty-six patients with chronic heart failure and left bundle-branch block (LBBB), who had undergone CRT, with mean age 59.9+/-10.8 years, left ventricular ejection fraction 30.9+/-8.3%, QRS 184+/-35 ms, FC (NYHA) II - 16%, III - 68% and IV - 16%, were selected. Through the 87-lead BSPM isochronous maps, ventricular activation times (VAT) of both right (RV) and left ventricles (LV) were analysed, in two situations: (1) native LBBB and (2) during biventricular pacing. After CRT, patients were divided in two groups: with and without FC improvement. The VATs were compared by the Mann-Whitney's test. The ratio of patients with and without FC improvement who showed RV-to-LV VAT difference =or<20 ms, and >20 ms, was compared using the Fisher's test. Significance level was accepted as p=or<0.05. RESULTS: Clinical characteristics of patients before CRT were similar in the groups. Patients with FC improvement (47) had RV-to-LV VAT difference during biventricular pacing shorter than those without FC improvement (14.40+/-13.0 ms vs 23.8+/-9.4 ms, p=0.0151). Moreover, the majority of patients with FC improvement had an RV-to-LV VAT difference =or<20 ms during biventricular pacing (70% vs 22%, RR 5.8, CI 95% 1.334-25.517, p=0.01). CONCLUSION: The RV-to-LV ventricular activation time difference of less than or equal to 20 milliseconds, as characterised by BSPM, could identify patients who presented with improved functional class after undergoing CRT.
Authors:
Nelson Samesima; Roberto Douglas; Nancy Tobias; Anísio Pedrosa; Martino Martinelli Filho; José Antonio Ramires; Carlos Alberto Pastore
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Publication Detail:
Type:  Evaluation Studies; Journal Article    
Journal Detail:
Title:  Anadolu kardiyoloji dergisi : AKD = the Anatolian journal of cardiology     Volume:  7 Suppl 1     ISSN:  1302-8723     ISO Abbreviation:  Anadolu Kardiyol Derg     Publication Date:  2007 Jul 
Date Detail:
Created Date:  2007-06-22     Completed Date:  2007-09-14     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  101095069     Medline TA:  Anadolu Kardiyol Derg     Country:  Turkey    
Other Details:
Languages:  eng     Pagination:  213-5     Citation Subset:  IM    
Affiliation:
Electrocardiology Service, Heart Institute of the University of São Paulo Medical School, São Paulo, Brazil. nsamesima@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Body Surface Potential Mapping*
Bundle-Branch Block / complications,  physiopathology*,  therapy
Cardiac Pacing, Artificial
Defibrillators, Implantable
Female
Heart Conduction System / physiopathology*
Heart Failure / complications,  physiopathology*,  therapy
Humans
Male
Middle Aged

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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