Ventricular electrical activation in cardiac resynchronization as characterized by body surface potential mapping.

OBJECTIVES

To assess cardiac electrical activation by using body surface potential mapping (BSPM), in patients with congestive heart failure (CHF) and left bundle branch block (LBBB) undergoing cardiac resynchronization therapy (CRT) with biventricular pacemaker (BIV-PM) implantation.

METHODS

Mean cardiac electrical activation times were analyzed in the right ventricle (RV) (mean RV activation time = mRV), anteroseptal area (mAS), and left ventricle (mLV) of 28 patients (mean age 61.2 +/- 9.5 years; NYHA class III-IV CHF; ejection fraction <40%; LBBB of mean QRS 181.2+/-19.4 ms, SAQRS -8.5 masculine+/-68.6 masculine), as shown in their BSPM isochronous maps, before and after implantation of atriobiventricular pacemaker, comparing those with values obtained from a control group of normal individuals [CG], in three situations: (1) native LBBB; (2) RV pacing; and (3) atriobiventricular pacing.

RESULTS

Situation (1): mRV and mAS values were similar (41.0+/-11.8 ms x 43.6+/-13.4 ms), with delayed mLV (81.0+/-12.5 ms, p<0.01) and asynchronous with RV and AS areas; situation (2): mRV was greater than in CG (86.8+/-22.9 ms, p<0.001), with greater difference between mAS and mLV (63.4+/-20.7 ms vs. 102.7+/-20.3 ms; p<0,001); situation (3): mLV and mRV were similar (72.0+/-32.0 ms vs. 71.6+/-32.3 ms), mRV was greater than in CG and native LBBB (71.6+/-32.3 ms vs. 35.1+/-10.9 ms and 41.0+/-11.8 ms; p<0.001), and mAS was close to CG and native LBBB values (51.3+/-32.8 ms vs. 50.1+/-11.4 ms and 43.6+/-13.4 ms).

CONCLUSION

The body surface potential mapping showed that RV and LV activation times which are similar, and are close to those of the AS area, suggest patterns of synchronized ventricular activation in patients with CHF and LBBB during atriobiventricular pacing.