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Cardiac resynchronization therapy (CRT) is an established class I level A biventricular pacing therapy in chronic heart failure patients with left bundle branch block and reduced left ventricular ejection fraction, but not all patients improved clinically. Purpose of the study was to evaluate electrical interatrial conduction delay (IACD) to interventricular conduction delay (IVCD) ratio with focused transesophageal left atrial and left ventricular electrocardiography.
Methods: Thirty eight chronic heart failure patients (age 63.4±10.2 years; 3 females, 35 males) with New York Heart Association (NYHA) functional class 3.0±0.2 and 171.71±36.17ms QRS duration were analysed using posterior left atrial and left ventricular transesophageal electrocardiography with hemispherical electrodes before CRT. Electrical IACD was measured between onset of P-wave in the surface ECG and onset of left atrial signal. Electrical IVCD was measured between onset of QRS complex in the surface ECG and onset of left ventricular signal.
Results: Electrical IACD and IVCD could be evaluated by transesophageal left atrial and left ventricular electrocardiography in all heart failure patients with correlation to 1.18±0.92 IACD-IVCD-ratio (r=-0.57, P<0.001; r=0.66, P<0.001). There were 32 CRT responder with reduction of NYHA class from 3.0±0.22 to 1.97±0.31 (P<0.001) during 16.5±18.9 month CRT with 75.19±33.49ms IACD, 78.91±24.73ms IVCD, 1.04±0.66 IACD-IVCD-ratio and correlation between IACD and IACDIVCD- ratio (r=0.84, P<0.001). There were 6 CRT nonresponder with no reduction of NYHA class from 3.0±0.3 to 2.9±0.5 during 14.3±13.7 month biventricular pacing, 50.0±28.26ms IVCD (P=0.014), 1.92±1.65 IACD-IVCD-ratio (P=0,029) and correlation between 67.0±24.9ms IACD and IACD-IVCD-ratio (r=0.85, P=0.031).
Conclusions: Focused transesophageal left atrial and left ventricular electrocardiography can be utilized to analyse electrical IACD and IVCD in heart failure patients. IACDIVDC- ratio may be a useful parameter to evaluate electrical left cardiac desynchronization in heart failure patients.
Cardiac resynchronization therapy (CRT) is an established biventricular pacing therapy in heart failure patients with left bundle branch block and reduced left ventricular ejection fraction, but not all patients improved clinically as CRT responder. Purpose of the study was to evaluate electrical left atrial conduction delay (LACD) with focused transesophageal electrocardiography in CRT responder and CRT non-responder.
Methods: Twenty heart failure patients (age 66.6±8.2 years; 2 females, 18 males) with New York Heart Association functional class 3.0±0.3 and 174.2±40.2ms QRS duration were analysed using posterior left atrial transesophageal electrocardiography with hemispherical electrodes. Electrical LACD was measured between onset and offset of transesophageal left atrial signal before implantation of CRT devices.
Results: Electrical LACD could be evaluated by bipolar transesophageal left atrial electrocardiography using TO Osypka electrode in all heart failure patients with negative correlation between 54.7±18.1ms LACD and 24.9±6.4% left ventricular ejection fraction (r=-0.65, P=0.002). There were 16 CRT responders with reduction of New York Heart Association functional class from 3.0±0.29 to 2.1±0.2 (r=0.522, P=0.038) during 9.41±10.96 month biventricular pacing and negative correlation between 49.6±14.2ms LACD and 26.0±6.2% left ventricular ejection fraction (r=-0.533, P=0.034). There were 4 CRT non-responders with no reduction of New York Heart Association functional class from 3.0±0.4 to 2.8±0.5 (r=0.816, P=0.184) during with 13.88±16.39 month biventricular pacing and no correlation between 75.25±19.17ms LACD and 20.75±6.4% left ventricular ejection fraction (r=-0.831, P=0.169).
Conclusions: Focused transesophageal left atrial electrocardiography can be utilized to analyse electrical LACD in heart failure patients. LACD correlated negative with left ventricular ejection fraction in CRT responders. LACD may be a useful parameter to evaluate electrical left atrial desynchronization in heart failure patients.