EFFECTS OF PACING SITE ON LEFT VENTRICULAR ACTIVATION SEQUENCES USING A NON-CONTACT MAPPING SYSTEM: IMPLICATIONS FOR HEART FAILURE PACING.

2004 ◽  
Vol 52 ◽  
pp. S357
Author(s):  
D. Xing ◽  
F. G. Devecchi ◽  
T. R. Staley ◽  
D. S. Glassman ◽  
J. B. Martins
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Contact Mapping ◽  
Mapping System ◽  
Ventricular Activation

68 EFFECTS OF PACING SITE ON LEFT VENTRICULAR ACTIVATION SEQUENCES USING A NON-CONTACT MAPPING SYSTEM: IMPLICATIONS FOR HEART FAILURE PACING.

2004 ◽  
Vol 52 (Suppl 2) ◽  
pp. S357.3-S357
Author(s):  
D. Xing ◽  
F. G. Devecchi ◽  
T. R. Staley ◽  
D. S. Glassman ◽  
J. B. Martins
Keyword(s):  
Heart Failure ◽  
Left Ventricular ◽  
Contact Mapping ◽  
Mapping System ◽  
Ventricular Activation

Abstract 13259: Electrophysiologic Mapping Identifies Stable Organized Tachyarrhythmias ("Rotors") in Both Atria during Spontaneous Atrial Fibrillation with Systolic Heart Failure

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Rangadham Nagarakanti ◽  
April Slee ◽  
Sanjeev Saksena
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Regional Distribution ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Activation Patterns ◽  
Ventricular Ejection Fraction ◽  
Contact Mapping ◽  
Premature Beats

Introduction: Stable organized atrial tachyarrhythmias (ATs) /"rotors" that maintain AF have been identified in patients (pts) with paroxysmal atrial fibrillation (PAF) & persistent AF (PRAF) with no or minimal heart disease. Hypothesis: Biatrial ATs occur in AF pts with systolic heart failure (HF). Methods: We performed simultaneous contact catheter mapping of the RA & LA using 3 D non-contact mapping ) in 83 refractory AF pts during spontaneous AF episodes.Spontaneous atrial premature beats (APBs) & triggered ATs were analyzed. We also compared regional distribution of ATs & activation patterns in pts with & without HF. Results: 24 HF pts, mean age of 62±9 years, 75% male with mean left ventricular ejection fraction (LVEF) 45.5±9% and mean left atrial (LA) size 4.35±0.8 cm were mapped. They had 42 APBs that triggered 26 distinct organized stable ATs/"rotors". Each pt had 1 to 4 RA or LA regions showing triggering APBs (mean 1.75/pt) initiating AT. APBs arose predominantly from the RA or LA septum (45%) & superior LA/PV (24%) regions (Fig 1a). A biatrial distribution of the stable ATs/"rotors" occcurred in HF pts (Fig 1b) with few focal ATs. Compared to pts without HF (n=59), HF pts (n=24) trended to have more PRAF (83% vs 66%, p=0.18). 78 organized stable ATs/"rotors" were compared for regional distribution in PRAF pts with HF (n=16) & without HF (n=32). Stable ATs with focal LA/PV origin were uncommon in both groups (7% vs. 15%). LA ATs/"rotors" were similar (26% vs. 17%; p=0.58) as were typical RA flutter and atypical RA ATs/"rotors" in both groups (Fig 1c). Conclusions: 1. A majority of APBs initiating AF in HF pts originated from the septal and superior LA/PV regions. 2. While triggers are still frequently present with the LA/PV origin in HF pts, stable ATs/"rotors" had biatrial distribution & a lesser frequency of focal LA/PV ATs. 3. This spectrum of ATs/"rotors" was similar to PRAF pts without HF, potentially supporting similar ablative interventions in both pt groups.

scholarly journals Prospective Assessment of an Automated Intraprocedural 12-Lead ECG-Based System for Localization of Early Left Ventricular Activation

2020 ◽  
Vol 13 (7) ◽  
Author(s):  
Shijie Zhou ◽  
Amir AbdelWahab ◽  
B. Milan Horáček ◽  
Paul J. MacInnis ◽  
James W. Warren ◽  
...  
Keyword(s):  
Population Based ◽  
Left Ventricular ◽  
Specific Site ◽  
Patient Specific ◽  
Localization Error ◽  
Localization Accuracy ◽  
Localization System ◽  
Contact Mapping ◽  
Ventricular Activation ◽  
Site Localization

Background: To facilitate ablation of ventricular tachycardia (VT), an automated localization system to identify the site of origin of left ventricular activation in real time using the 12-lead ECG was developed. The objective of this study was to prospectively assess its accuracy. Methods: The automated site of origin localization system consists of 3 steps: (1) localization of ventricular segment based on population templates, (2) population-based localization within a segment, and (3) patient-specific site localization. Localization error was assessed by the distance between the known reference site and the estimated site. Results: In 19 patients undergoing 21 catheter ablation procedures of scar-related VT, site of origin localization accuracy was estimated using 552 left ventricular endocardial pacing sites pooled together and 25 VT-exit sites identified by contact mapping. For the 25 VT-exit sites, localization error of the population-based localization steps was within 10 mm. Patient-specific site localization achieved accuracy of within 3.5 mm after including up to 11 pacing (training) sites. Using 3 remotes (67.8±17.0 mm from the reference VT-exit site), and then 5 close pacing sites, resulted in localization error of 7.2±4.1 mm for the 25 identified VT-exit sites. In 2 emulated clinical procedure with 2 induced VTs, the site of origin localization system achieved accuracy within 4 mm. Conclusions: In this prospective validation study, the automated localization system achieved estimated accuracy within 10 mm and could thus provide clinical utility.

scholarly journals Left ventricular activation-recovery interval variability predicts spontaneous ventricular tachyarrhythmia in patients with heart failure

Heart Rhythm ◽  
2019 ◽  
Vol 16 (5) ◽  
pp. 702-709 ◽  
Author(s):  
Bradley Porter ◽  
Martin J. Bishop ◽  
Simon Claridge ◽  
Nicholas Child ◽  
Stefan Van Duijvenboden ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Tachyarrhythmia ◽  
Left Ventricular ◽  
Recovery Interval ◽  
Patients With Heart Failure ◽  
Ventricular Activation

scholarly journals Characterization of Left Ventricular Activation in Patients With Heart Failure and Left Bundle-Branch Block

Circulation ◽  
2004 ◽  
Vol 109 (9) ◽  
pp. 1133-1139 ◽  
Author(s):  
Angelo Auricchio ◽  
Cecilia Fantoni ◽  
Francois Regoli ◽  
Corrado Carbucicchio ◽  
Andreas Goette ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Bundle Branch Block ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
Patients With Heart Failure ◽  
Ventricular Activation

scholarly journals His Bundle Pacing: A New Frontier in the Treatment of Heart Failure

2018 ◽  
Vol 7 (2) ◽  
pp. 103 ◽  
Author(s):  
Nadine Ali ◽  
Daniel Keene ◽  
Ahran Arnold ◽  
Matthew Shun-Shin ◽  
Zachary I Whinnett ◽  
...  
Keyword(s):  
Heart Failure ◽  
Left Bundle Branch Block ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
Bundle Branch Block ◽  
His Bundle ◽  
His Bundle Pacing ◽  
Lead Placement ◽  
Ventricular Lead ◽  
Ventricular Activation

Biventricular pacing has revolutionised the treatment of heart failure in patients with sinus rhythm and left bundle branch block; however, left ventricular-lead placement is not always technically possible. Furthermore, biventricular pacing does not fully normalise ventricular activation and, therefore, the ventricular resynchronisation is imperfect. Right ventricular pacing for bradycardia may cause or worsen heart failure in some patients by causing dyssynchronous ventricular activation. His bundle pacing activates the ventricles via the native His-Purkinje system, resulting in true physiological pacing, and, therefore, is a promising alternate site for pacing in bradycardia and traditional CRT indications in cases where it can overcome left bundle branch block. Furthermore, it may open up new indications for pacing therapy in heart failure, such as targeting patients with PR prolongation, but a narrow QRS duration. In this article we explore the physiology, technology and potential roles of His bundle pacing in the prevention and treatment of heart failure.

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