TY - JOUR
T1 - Vectorcardiographic QRS area identifies delayed left ventricular lateral wall activation determined by electroanatomic mapping in candidates for cardiac resynchronization therapy
AU - Rad, Masih Mafi
AU - Wijntjens, Gilbert W. M.
AU - Engels, Elien B.
AU - Blaauw, Yuri
AU - Luermans, Justin G. L. M.
AU - Pison, Laurent
AU - Crijns, Harry J.
AU - Prinzen, Frits W.
AU - Vernooy, Kevin
PY - 2016/1
Y1 - 2016/1
N2 - 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 μVs vs 51 ± 27 μVs, P <.001), and identified delayed LVLW activation better than QRS duration (area under the curve 0.89 [95% confidence interval 0.79-0.99] vs 0.49 [95% confidence interval 0.33-0.65]). QRS AREA >69 μVs 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. QRS AREA is a noninvasive alternative for intracardiac measurements of electrical activation, which identifies delayed LVLW activation better than QRS duration and LBBB morphology.
AB - 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 μVs vs 51 ± 27 μVs, P <.001), and identified delayed LVLW activation better than QRS duration (area under the curve 0.89 [95% confidence interval 0.79-0.99] vs 0.49 [95% confidence interval 0.33-0.65]). QRS AREA >69 μVs 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. QRS AREA is a noninvasive alternative for intracardiac measurements of electrical activation, which identifies delayed LVLW activation better than QRS duration and LBBB morphology.
KW - Cardiac resynchronization therapy
KW - Coronary venous electroanatomic mapping
KW - Vectorcardiography
KW - Left ventricular conduction delay
KW - Left bundle branch block
UR - http://www.scopus.com/inward/record.url?scp=84955447005&partnerID=8YFLogxK
U2 - 10.1016/j.hrthm.2015.07.033
DO - 10.1016/j.hrthm.2015.07.033
M3 - Article
C2 - 26232766
SN - 1547-5271
VL - 13
SP - 217
EP - 225
JO - Heart Rhythm
JF - Heart Rhythm
IS - 1
ER -