Bank Alan J, Brown Christopher D, Burns Kevin V, Espinosa Emanuel A, Harbin Michelle M
Minneapolis Heart Institute East, Allina Health, St. Paul, MN, USA; Cardiology Division, Department of Medicine, University of Minnesota, Minneapolis, MN, USA; Heart Rhythm Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
Minneapolis Heart Institute East, Allina Health, St. Paul, MN, USA.
J Electrocardiol. 2022 Sep-Oct;74:73-81. doi: 10.1016/j.jelectrocard.2022.08.006. Epub 2022 Aug 27.
There is no clinical methodology for quantification or display of electrical dyssynchrony over a wide range of atrial-ventricular delays (AVD) and ventricular-ventricular delays (VVD) in patients with cardiac resynchronization therapy (CRT). This study aimed to develop a new methodology, based on wavefront fusion, for mapping electrical synchrony.
A cardiac resynchronization index (CRI) was measured at multiple device settings in 90 patients. Electrical dyssynchrony maps (EDM) were constructed for each patient to display CRI at any combination of AVD and VVD. An optimal synchrony line (OSL) depicted the AVD/VVD combinations producing the highest CRIs. Fusion of right ventricular paced (RVp), left ventricular paced (LVp), and native wavefront offsets were calculated.
CRI significantly increased (p < 0.0001) from 58.0 ± 28.1% at baseline to 98.3 ± 1.7% at optimized settings. EDMs in patients with high-grade heart block (n = 20) had an OSL parallel to the simultaneous biventricular pacing (BiVP) line with leftward shift across all AVDs (RVp-LVp = 50.5 ± 29.8 ms). EDMs in patients with intact AV node conduction (n = 64) had an OSL parallel to the BiVP line with leftward shift at short AVDs (RVp-LVp = 33.4 ± 23.3 ms), curvilinear at intermediate AVDs (triple fusion), and vertical at long AVDs (native-LVp = 85.2 ± 22.8 ms) in all patients except those with poor LV lead position (n = 6).
A new methodology is described for quantifying and graphing electrical dyssynchrony over a physiologic range of AVDs/VVDs. This methodology offers a noninvasive, practical, clinical approach for measuring electrical synchrony that could be applied to optimization of CRT devices.
对于接受心脏再同步治疗（CRT）的患者，目前尚无临床方法可在广泛的房室延迟（AVD）和室间延迟（VVD）范围内对电不同步进行量化或显示。本研究旨在开发一种基于波前融合的新方法来绘制电同步图。
在90例患者的多个设备设置下测量心脏再同步指数（CRI）。为每位患者构建电不同步图（EDM），以显示在任何AVD和VVD组合下的CRI。绘制出最佳同步线（OSL），以描绘产生最高CRI的AVD/VVD组合。计算右心室起搏（RVp）、左心室起搏（LVp）和固有波前偏移的融合情况。
CRI从基线时的58.0±28.1%显著增加（p<0.0001）至优化设置时的98.3±1.7%。高度房室传导阻滞患者（n = 20）的EDM有一条与双心室同步起搏（BiVP）线平行的OSL，在所有AVD中均向左偏移（RVp - LVp = 50.5±29.8毫秒）。房室结传导完整的患者（n = 64）的EDM有一条与BiVP线平行的OSL，在短AVD时向左偏移（RVp - LVp = 33.4±23.3毫秒），在中等AVD时呈曲线形（三重融合），在长AVD时垂直（固有 - LVp = 85.2±22.8毫秒），除左心室导联位置不佳的患者（n = 6）外。
描述了一种新方法，用于在生理范围AVD/VVD内量化和绘制电不同步情况。该方法为测量电同步提供了一种非侵入性、实用的临床方法，可应用于CRT设备的优化。
