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Differential effect with septal and apical RV pacing on ventricular activation in patients with left bundle branch block assessed by non-invasive electrical imaging and in silico modelling.

Authors
  • Jackson, T1, 2
  • Claridge, S3
  • Behar, J3
  • Sieniewicz, B3
  • Gould, J3
  • Porter, B3
  • Sidhu, B3
  • Yao, C4
  • Lee, A3
  • Niederer, S3
  • Rinaldi, C A3, 5
  • 1 Department of Imaging Sciences, St Thomas' Hospital, King's College London, London, SE1, UK. [email protected]
  • 2 Department of Cardiology, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, SP2 8BJ, UK. [email protected]
  • 3 Department of Imaging Sciences, St Thomas' Hospital, King's College London, London, SE1, UK.
  • 4 Medtronic/CardioInsight, Cleveland, OH, USA.
  • 5 Guy's and St Thomas' NHS Trust, King's College London, London, SE1 9RT, UK.
Type
Published Article
Journal
Journal of Interventional Cardiac Electrophysiology
Publisher
Springer-Verlag
Publication Date
Jan 01, 2020
Volume
57
Issue
1
Pages
115–123
Identifiers
DOI: 10.1007/s10840-019-00567-2
PMID: 31201592
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

It is uncertain whether right ventricular (RV) lead position in cardiac resynchronization therapy impacts response. There has been little detailed analysis of the activation patterns in RV septal pacing (RVSP), especially in the CRT population. We compare left bundle branch block (LBBB) activation patterns with RV pacing (RVP) within the same patients with further comparison between RV apical pacing (RVAP) and RVSP. Body surface mapping was undertaken in 14 LBBB patients after CRT implantation. Nine patients had RVAP, 5 patients had RVSP. Activation parameters included left ventricular total activation time (LVtat), biventricular total activation time (VVtat), interventricular electrical synchronicity (VVsync), and dispersion of left ventricular activation times (LVdisp). The direction of activation wave front was also compared in each patient (wave front angle (WFA)). In silico computer modelling was applied to assess the effect of RVAP and RVSP in order to validate the clinical results. Patients were aged 64.6 ± 12.2 years, 12 were male, 8 were ischemic. Baseline QRS durations were 157 ± 18 ms. There was no difference in VVtat between RVP and LBBB but a longer LVtat in RVP (102.8 ± 19.6 vs. 87.4 ± 21.1 ms, p = 0.046). VVsync was significantly greater in LBBB (45.1 ± 20.2 vs. 35.9 ± 17.1 ms, p = 0.01) but LVdisp was greater in RVP (33.4 ± 5.9 vs. 27.6 ± 6.9 ms, p = 0.025). WFA did rotate clockwise with RVP vs. LBBB (82.5 ± 25.2 vs. 62.1 ± 31.7 op = 0.026). None of the measurements were different to LBBB with RVSP; however, the differences were preserved with RVAP for VVsync, LVdisp, and WFA. In silico modelling corroborated these results. RVAP activation differs from LBBB where RVSP appears similar. (ClinicalTrials.gov identifier: NCT01831518).

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