Characterizing left ventricular mechanical and electrical activation in patients with normal and impaired systolic function using a non-fluoroscopic cardiovascular navigation system

Christopher Piorkowski*, Arash Arya, Craig D. Markovitz, Hedi Razavi, Chunlan Jiang, Stuart Rosenberg, Ole-A. Breithardt, Sascha Rolf, Silke John, Jedrzej Kosiuk, Yan Huo, Michael Doring, Sergio Richter, Kyungmoo Ryu, Thomas Gaspar, Frits W. Prinzen, Gerhard Hindricks, Philipp Sommer

*Corresponding author for this work

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Abstract

Cardiac disease frequently has a degenerative effect on cardiac pump function and regional myocardial contraction. Therefore, an accurate assessment of regional wall motion is a measure of the extent and severity of the disease. We sought to further validate an intra-operative, sensor-based technology for measuring wall motion and strain by characterizing left ventricular (LV) mechanical and electrical activation patterns in patients with normal (NSF) and impaired systolic function (ISF). NSF (n = 10; ejection fraction = 62.9 +/- 6.1%) and ISF (n = 18; ejection fraction = 35.1 +/- 13.6%) patients underwent simultaneous electrical and motion mapping of the LV endocardium using electroanatomical mapping and navigational systems (EnSite (TM) NavX (TM) and MediGuide (TM), Abbott). Motion trajectories, strain profiles, and activation times were calculated over the six standard LV walls. NSF patients had significantly greater motion and systolic strains across all LV walls than ISF patients. LV walls with low-voltage areas showed less motion and systolic strain than walls with normal voltage. LV electrical dyssynchrony was significantly smaller in NSF and ISF patients with narrow-QRS complexes than ISF patients with wide-QRS complexes, but mechanical dyssynchrony was larger in all ISF patients than NSF patients. The latest mechanical activation was most often the lateral/posterior walls in NSF and wide-QRS ISF patients but varied in narrow-QRS ISF patients. This intra-operative technique can be used to characterize LV wall motion and strain in patients with impaired systolic function. This technique may be utilized clinically to provide individually tailored LV lead positioning at the region of latest mechanical activation for patients undergoing cardiac resynchronization therapy.
Original languageEnglish
Pages (from-to)205-214
Number of pages10
JournalJournal of Interventional Cardiac Electrophysiology
Volume51
Issue number3
DOIs
Publication statusPublished - 1 Apr 2018

Keywords

  • Left ventricular wall motion
  • Left ventricular strain
  • Electrophysiology mapping
  • Dyssynchrony
  • Cardiac resynchronization therapy
  • CARDIAC-RESYNCHRONIZATION THERAPY
  • HEART-FAILURE PATIENTS
  • NARROW QRS COMPLEX
  • LEAD PLACEMENT
  • DYSSYNCHRONY
  • DELAY
  • ECHOCARDIOGRAPHY
  • TECHNOLOGY
  • MORTALITY
  • DURATION

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