Vectorcardiographic QRS area identifies delayed left ventricular lateral wall activation determined by electroanatomic mapping in candidates for cardiac resynchronization therapy

Masih Mafi Rad, Gilbert W. M. Wijntjens, Elien B. Engels, Yuri Blaauw, Justin G. L. M. Luermans, Laurent Pison, Harry J. Crijns, Frits W. Prinzen, Kevin Vernooy*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


BACKGROUND Delayed left ventricular (LV) lateral wall (LVLW) activation is considered the electrical substrate underlying LV dysfunction amenable to cardiac resynchronization therapy (CRT). OBJECTIVE The purpose of this study was to assess LVLW activation in CRT candidates using coronary venous electroanatomic mapping (EAM) and to investigate whether the QRS area (QRS(AREA)) on the vectorcardiogram (VCG) can identify delayed LVLW activation. METHODS Fifty-one consecutive CRT candidates (29 left bundle branch block [LBBB], 15 intraventricular conduction delay [IVCD], 7 right bundle branch block [RBBB]) underwent intraprocedural coronary venous EAM using EnSite NavX. VCGs were constructed from preprocedural digital 12-lead ECGs using the Kors method. QRS(AREA) was assessed and compared to QRS duration and 5 different LBBB definitions. RESULTS Delayed LVLW activation (activation time >75% of QRS duration) occurred in 38 of 51 patients (29/29 LBBB, 8/15 IVCD, 1/7 RBBB). QRS(AREA) was larger in patients with than in patients without delayed LVLW activation (108 +/- 42 mu Vs vs 51 +/- 27 mu Vs, P 69 mu Vs diagnosed delayed LVLW activation with a higher sum of sensitivity (87%) and specificity (92%) than any of the LBBB definitions. Of the different LBBB definitions, the European Society of Cardiology textbook definition performed best with sensitivity of 76% and specificity of 100%. CONCLUSION Coronary venous EAM can be used during CRT implantation to determine the presence of delayed LVLW activation. QRSAREA is a noninvasive alternative for intracardiac measurements of electrical activation, which identifies delayed LVLW activation better than QRS duration and LBBB morphology.
Original languageEnglish
Pages (from-to)217-225
JournalHeart Rhythm
Issue number1
Publication statusPublished - Jan 2016


  • Cardiac resynchronization therapy
  • Coronary venous electroanatomic mapping
  • Vectorcardiography
  • Left ventricular conduction delay
  • Left bundle branch block

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