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Cardiac resynchronization therapy (CRT) with biventricular pacing is an established therapy for heart failure (HF) patients (P) with ventricular desynchronization and reduced left ventricular (LV) ejection fraction. The aim of this study was to evaluate electrical right atrial (RA), left atrial (LA), right ventricular (RV) and LV conduction delay with novel telemetric signal averaging electrocardiography (SAECG) in implantable cardioverter defibrillator (ICD) P to better select P for CRT and to improve hemodynamics in cardiac pacing.
Methods: ICD-P (n=8, age 70.8 ± 9.0 years; 2 females, 6 males) with VVI-ICD (n=4), DDD-ICD (n=3) and CRT-ICD (n=1) (Medtronic, Inc., Minneapolis, MN, USA) were analysed with telemetric ECG recording by Medronic programmer 2090, ECG cable 2090AB, PCSU1000 oscilloscope with Pc-Lab2000 software (Velleman®) and novel National Intruments LabView SAECG software.
Results: Electrical RA conduction delay (RACD) was measured between onset and offset of RA deflection in the RAECG. Interatrial conduction delay (IACD) was measured between onset of RA deflection and onset of far-field LA deflection in the RAECG. Interventricular conduction delay (IVCD) was measured between onset of RV deflection in the RVECG and onset of LV deflection in the LVECG. Telemetric SAECG recording was possible in all ICD-P with a mean of 11.7 ± 4.4 SAECG heart beats, 97.6 ± 33.7 ms QRS duration, 81.5 ± 44.6 ms RACD, 62.8 ± 28.4 ms RV conduction delay, 143.7 ± 71.4 ms right cardiac AV delay, 41.5 ms LA conduction delay, 101.6 ms LV conduction delay, 176.8 ms left cardiac AV delay, 53.6 ms IACD and 93 ms IVCD.
Conclusions: Determination of RA, LA, RV and LV conduction delay, IACD, IVCD, right and left cardiac AV delay by telemetric SAECG recording using LabView SAECG technique may be useful parameters of atrial and ventricular desynchronization to improve P selection for CRT and hemodynamics in cardiac pacing.
Cardiac resynchronisation therapy (CRT) with biventricular pacing (BV) is an established therapy for heart failure (HF) patients with interventricular conduction delay (IVCD). The aim of the study was to evaluate transesophageal IVCD and left ventricular (LV) pacing with directed electrical pacing field (EPF) in HF patients.
Methods: HF patients were analysed with bipolar transesophageal LV electrocardiogram recording and LV pacing with constant voltage stimulus output, 4 ms stimulus duration, distal cylindrical electrode (CE) and seven 6 mm hemispherical electrodes (HE) with 15 mm electrode distance (TO, Dr. Osypka, Rheinfelden, Germany).
Results: LV electrocardiogram recording with HE-HE and CE-HE evaluated a mean IVCD of 79.9 ± 36.7 ms. Directed EPF with CE-HE and HE-HE allowed LV VAT (n=12) and LV D00 pacing (n=5) with a mean effective capture output of 97.35 ± 6.64 V. In 15 responders with IVCD of 87 ± 33 ms arterial pulse pressure (PP) increased from 65 ± 24 mmHg to 79 ± 27 mmHg (p < 0.001). EPF was simulated with finite element method.
Conclusions: Transesophageal LV electrocardiography and directed EPF pacing with CE and HE allowed the evaluation of IVCD and PP to select patients for BV pacing.