Distinctive Left Ventricular Activations Associated With ECG Pattern in Heart Failure Patients

Nicolas Derval*, Josselin Duchateau, Saagar Mahida, Romain Eschalier, Frederic Sacher, Joost Lumens, Hubert Cochet, Arnaud Denis, Xavier Pillois, Seigo Yamashita, Yuki Komatsu, Sylvain Ploux, Sana Amraoui, Adlane Zemmoura, Philippe Ritter, Meleze Hocini, Michel Haissaguerre, Pierre Jais, Pierre Bordachar

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Background-In contrast to patients with left bundle branch block (LBBB), heart failure patients with narrow QRS and nonspecific intraventricular conduction delay (NICD) display a relatively limited response to cardiac resynchronization therapy. We sought to compare left ventricular (LV) activation patterns in heart failure patients with narrow QRS and NICD to patients with LBBB using high-density electroanatomic activation maps.

Methods and Results-Fifty-two heart failure patients (narrow QRS [n = 18], LBBB [n = 11], NICD [n = 23]) underwent 3-dimensional electroanatomic mapping with a high density of mapping points (387 +/- 349 LV). Adjunctive scar imaging was available in 37 (71%) patients and was analyzed in relation to activation maps. LBBB patients typically demonstrated (1) a single LV breakthrough at the septum (38 +/- 15 ms post-QRS onset); (2) prolonged right-to-left transseptal activation with absence of direct LV Purkinje activity; (3) homogeneous propagation within the LV cavity; and (4) latest activation at the basal lateral LV. In comparison, both NICD and narrow QRS patients demonstrated (1) multiple LV breakthroughs along the posterior or anterior fascicles: narrow QRS versus LBBB, 5 +/- 2 versus 1 +/- 1; P = 0.0004; NICD versus LBBB, 4 +/- 2 versus 1 +/- 1; P = 0.001); (2) evidence of early/pre-QRS LV electrograms with Purkinje potentials; (3) rapid propagation in narrow QRS patients and more heterogeneous propagation in NICD patients; and (4) presence of limited areas of late activation associated with LV scar with high interindividual heterogeneity.

Conclusions-In contrast to LBBB patients, narrow QRS and NICD patients are characterized by distinct mechanisms of LV activation, which may predict poor response to cardiac resynchronization therapy.

Original languageEnglish
Article numbere005073
Number of pages10
JournalCirculation-Arrhythmia and Electrophysiology
Volume10
Issue number6
DOIs
Publication statusPublished - Jun 2017

Keywords

  • cardiac resynchronization therapy
  • heart failure
  • left bundle branch block
  • mapping
  • resynchronization
  • CARDIAC-RESYNCHRONIZATION THERAPY
  • BUNDLE-BRANCH-BLOCK
  • MULTIDETECTOR COMPUTED-TOMOGRAPHY
  • OF-THE-ART
  • QRS DURATION
  • CLINICAL CARDIOLOGY
  • MORPHOLOGY
  • GUIDELINES
  • STATEMENT
  • COMMITTEE

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