Document Detail

Ventricular activation patterns during different pacing modes. An insight from electroanatomical mapping.
MedLine Citation:
PMID:  16380863     Owner:  NLM     Status:  MEDLINE    
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+/-8 years) with chronic heart failure, intraventricular conduction abnormality (QRS >130 ms) 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.
Petr Peichl; Josef Kautzner; Robert Cihak; Lucie Riedlbauchova; Jan Bytesnik
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Kardiologia polska     Volume:  63     ISSN:  0022-9032     ISO Abbreviation:  Kardiol Pol     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-28     Completed Date:  2006-07-26     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0376352     Medline TA:  Kardiol Pol     Country:  Poland    
Other Details:
Languages:  eng     Pagination:  622-32; ; discussion 633-5     Citation Subset:  IM    
Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídenská 1958/9, 14021 Praha 4, Czech Republic.
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MeSH Terms
Cardiac Pacing, Artificial / methods*
Heart Failure / etiology,  surgery*
Heart Septum / physiopathology
Heart Ventricles / anatomy & histology*,  physiopathology*
Middle Aged
Ventricular Dysfunction, Right / complications,  physiopathology

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