Wilczek Jacek, Jadczyk Tomasz, Wojakowski Wojciech, Gołba Krzysztof S
Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland.
Electrocardiology Department, Upper Silesian Medical Center, Katowice, Poland.
Front Cardiovasc Med. 2023 May 4;10:1107415. doi: 10.3389/fcvm.2023.1107415. eCollection 2023.
The aim of the study was to determine whether left ventricular electrical potential measured by electromechanical mapping with the NOGA XP system has predictive value for response to CRT.
Approximately 30% of patients who undergo cardiac resynchronization therapy do not see the expected effects.
The group of 38 patients qualified for CRT implantation were included in the study, of which 33 patients were analyzed. A 15% reduction in ESV after 6 months of pacing was used as a criterion for a positive response to CRT. The mean value and sum of unipolar and bipolar potentials obtained by mapping with the NOGA XP system and their predictive value in relation to the effect of CRT were analyzed using a bulls-eye projection at three levels: 1) the global value of the left ventricular (LV) potentials, 2) the potentials of the individual LV walls and 3) the mean value of the potentials of the individual segments (basal and middle) of the individual LV walls.
24 patients met the criterion of a positive response to CRT vs. 9 non-responders. At the global analysis stage, the independent predictors of favorable response to CRT were the sum of the unipolar potential and bipolar mean potential. In the analysis of individual left ventricular walls, the mean bipolar potential of the anterior and posterior wall and in the unipolar system, mean septal potential was found to be an independent predictor of favorable response to CRT. In the detailed segmental analysis, the independent predictors were the bipolar potential of the mid-posterior wall segment and the basal anterior wall segment.
Measurement of bipolar and unipolar electrical potentials with the NOGA XP system is a valuable method for predicting a favorable response to CRT.
本研究旨在确定使用NOGA XP系统通过机电标测测量的左心室电位对心脏再同步治疗（CRT）反应是否具有预测价值。
接受心脏再同步治疗的患者中约有30%未见到预期效果。
38例符合CRT植入条件的患者纳入研究，其中33例患者进行了分析。以起搏6个月后左室收缩末期容积（ESV）降低15%作为对CRT反应阳性的标准。使用靶心图投影在三个层面分析通过NOGA XP系统标测获得的单极和双极电位的平均值、总和及其与CRT效果相关的预测价值：1）左心室（LV）电位的整体值；2）各个LV壁的电位；3）各个LV壁的各个节段（基底段和中间段）电位的平均值。
24例患者符合CRT反应阳性标准，9例为无反应者。在整体分析阶段，对CRT反应良好的独立预测因素是单极电位总和与双极平均电位。在对各个左心室壁的分析中，发现前壁和后壁的平均双极电位以及在单极系统中，间隔平均电位是对CRT反应良好的独立预测因素。在详细的节段分析中，独立预测因素是后壁中间段和前壁基底段的双极电位。
使用NOGA XP系统测量双极和单极电位是预测对CRT良好反应的有价值方法。
