Right and left ventricular activation sequence in patients with heart failure and right bundle branch block: A detailed analysis using three-dimensional non-fluoroscopic electroanatomic mapping system

被引:137
作者
Fantoni, C
Kawabata, M
Massaro, R
Regoli, F
Raffa, S
Arora, V
Salerno-Uriarte, JA
Klein, HU
Auricchio, A
机构
[1] Univ Hosp, Div Cardiol, D-39120 Magdeburg, Germany
[2] Univ Insubria, Dept Cardiovasc Sci, Varese, Italy
[3] IRCCS Casa Sollievo Sofferenza, Div Cardiol, San Giovanni Rotondo, Italy
[4] Univ Messina, Div Cardiol, I-98100 Messina, Italy
关键词
cardiac resynchronization therapy; heart failure; mapping; right bundle branch block; ventricular conduction disturbances;
D O I
10.1046/j.1540-8167.2005.40777.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Three-Dimensional Mapping in RBBB and Heart Failure. Introduction: Recently, right bundle branch block (RBBB) was proved to be an important predictor of mortality in heart failure (HF) patients as much as left bundle branch block (LBBB). We characterized endocardial right ventricular (RV) and left ventricular (LV) activation sequence in HF patients with RBBB using a three-dimensional non-fluoroscopic electroanatomic contact mapping system (3D-Map) in order to provide the electrophysiological background to understand whether these patients can benefit from cardiac resynchronization therapy (CRT). Methods and Results: Using 3D-Map, RV and LV activation sequences were studied in 100 consecutive HF patients. Six of these patients presented with RBBB QRS morphology. The maps of these patients were analyzed and compared post hoc with those of the other 94 HF patients presenting with LBBB. Clinical and hemodynamic profile was significantly worse in RBBB group compared to LBBB. Patients with RBBB showed significantly longer time to RV breakthrough (P < 0.001), longer activation times of RV anterior and lateral regions (P < 0.001), and longer total RV endocardial activation time (P < 0.02) compared to patients with LBBB. Time to LV breakthrough was significantly shorter in patients with RBBB (P < 0.001), while total and regional LV endocardial activation times were not significantly different between the two groups. Conclusions: Degree of LV activation delay is similar between HF patients with LBBB and RBBB. Moreover, patients with RBBB have larger right-sided conduction delay compared to patients with LBBB. The assessment of these electrical abnormalities is important to understand the rationale for delivering CRT in HF patients with RBBB.
引用
收藏
页码:112 / 119
页数:8
相关论文
共 26 条
  • [1] Abraham WT, 2002, NEW ENGL J MED, V346, P1902
  • [2] Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay
    Auricchio, A
    Stellbrink, C
    Sack, S
    Block, M
    Vogt, J
    Bakker, P
    Huth, C
    Schöndube, F
    Wolfhard, U
    Böcker, D
    Krahnefeld, O
    Kirkels, H
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 39 (12) : 2026 - 2033
  • [3] Characterization of left ventricular activation in patients with heart failure and left bundle-branch block
    Auricchio, A
    Fantoni, C
    Regoli, F
    Carbucicchio, C
    Goette, A
    Geller, C
    Kloss, M
    Klein, H
    [J]. CIRCULATION, 2004, 109 (09) : 1133 - 1139
  • [4] Nonfluoroscopic, in vivo navigation and mapping technology
    BenHaim, SA
    Osadchy, D
    Schuster, I
    Gepstein, L
    Hayam, G
    Josephson, ME
    [J]. NATURE MEDICINE, 1996, 2 (12) : 1393 - 1395
  • [5] Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure
    Bristow, MR
    Saxon, LA
    Boehmer, J
    Krueger, S
    Kass, DA
    De Marco, T
    Carson, P
    DiCarlo, L
    DeMets, D
    White, BG
    DeVries, DW
    Feldman, AM
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (21) : 2140 - 2150
  • [6] Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients
    Butter, C
    Auricchio, A
    Stellbrink, C
    Fleck, E
    Ding, J
    Yu, YH
    Huvelle, E
    Spinelli, J
    [J]. CIRCULATION, 2001, 104 (25) : 3026 - 3029
  • [7] Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay.
    Cazeau, S
    Leclercq, C
    Lavergne, T
    Walker, S
    Varma, C
    Linde, C
    Garrigue, S
    Kappenberger, L
    Haywood, GA
    Santini, M
    Bailleul, C
    Daubert, JC
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2001, 344 (12) : 873 - 880
  • [8] Mechanical dyssynchrony in dilated cardiomyopathy with intraventricular conduction delay as depicted by 3D tagged magnetic resonance imaging
    Curry, CW
    Nelson, GS
    Wyman, BT
    Declerck, J
    Talbot, M
    Berger, RD
    McVeigh, ER
    Kass, DA
    [J]. CIRCULATION, 2000, 101 (01) : E2 - E2
  • [9] Electrical resynchronization - A novel therapy for the failing right ventricle
    Dubin, AM
    Feinstein, JA
    Reddy, VM
    Hanley, FL
    Van Hare, GF
    Rosenthal, DN
    [J]. CIRCULATION, 2003, 107 (18) : 2287 - 2289
  • [10] LEFT-BUNDLE BRANCH-BLOCK - A CONTINUOUSLY EVOLVING CONCEPT
    FLOWERS, NC
    [J]. JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 1987, 9 (03) : 684 - 697