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Novel semi-invasive left-heart electrogram feature to select patients with atrial fibrillation for cardiac resynchronization

  • About 20% of those heart failure patients receiving cardiac resynchronization therapy (CRT) are in atrial fibrillation (AF). Current guidelines apply for patients in sinus rhythm only. Recent studies have shown again, that successful resynchronization is closely linked to a pre-existent ventricular desynchronization. In those studies, the interventricular conduction delay (IVCD) was determinedAbout 20% of those heart failure patients receiving cardiac resynchronization therapy (CRT) are in atrial fibrillation (AF). Current guidelines apply for patients in sinus rhythm only. Recent studies have shown again, that successful resynchronization is closely linked to a pre-existent ventricular desynchronization. In those studies, the interventricular conduction delay (IVCD) was determined prior to device implantation by ultrasound in patients with sinus rhythm (SR)only. In patients with AF this method ́s use is limited. To implement left-heart electrogram (LHE) into standard programmers and to simplify IVCD measurement in heart failure patients with AF, LHE was recorded in 11 AF patients with heart failure by Biotronik ICS3000 programmer via a15Hz Butterworth high-pass filter. Therefore, TOslim esophageal electrode (Dr. Osypka GmbH, Rheinfelden, Germany) was perorally applied and fixed in position of maximal left ventricular defection. IVCD was measured between onset of QRS in surface ECG and left ventricular defection (LV) in LHE. In addition, intra-left ventricular conduction delay (ILVCD) was measured as duration of LV in LHE. In all of the 11 AF patients, desynchronization was quantifiable by LHE. Mean QRS of 162 ± 27ms (120-206ms) was linked with IVCD of 62ms ± 27ms (37-98ms) and ILVCD of 110 ± 20ms (80-144ms), at mean. Correlation between IVCD and QRS was 0.39 (n. s.) with IVCD/QRS ratio of 0.38 ± 0.11 (0.22-0.81). A 15Hz high-pass filtered LHE feature of the Biotronik ICS3000 programmer is feasible to quantify ventricular dyssynchrony in heart failure patients with AF in order to clearly indicate implantation of CRT systems. As relations between QRS duration, IVCD and ILVCD considerably differ interindividually, the predictive values of IVCD, ILVCD and IVCD/QRS ratio for individual CRT response or non-response shall be identified in follow-up studies.show moreshow less

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Metadaten
Author:Katharina Kroll, Kirsten-Maria Rotter, Matthias HeinkeGND, Juraj Melichercik, Christoph A. Nienaber, Bruno IsmerGND
Publisher:Walter de Gruyter
Place of publication:Berlin, Boston
Date of Publication (online):2012/08/31
Language:German
DDC classes:600 Technik, Medizin, angewandte Wissenschaften / 610 Medizin, Gesundheit
Parent Title (German):Biomedical Engineering / Biomedizinische Technik
Volume:57
Issue:SI-1 Track-I
ISSN:0013-5585 (Print)
ISSN:1862-278X (Online)
First Page:1102
Last Page:1103
Document Type:Conference Proceeding
Institutes:Hochschule Offenburg / Bibliografie
Release Date:2015/02/16
Licence (German):License LogoEs gilt das UrhG
Note:
Proceedings BMT 2012, 46. DGBMT Jahrestagung, Jena - Track I. Clinical Engineering, 16.-19.09.2012
DOI:https://doi.org/10.1515/bmt-2012-4009