Depolarization spatial variance as a cardiac dyssynchrony descriptor

Bonomini, Maria Paula; Ortega, Daniel F.; Barja, Luis D.; Mangani, N; Arini, Pedro David

doi:10.1016/j.bspc.2018.12.009

Cited by 10 publications

(5 citation statements)

References 21 publications

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“…Synchromax® is nothing more than a sophisticated non-invasive electrical surface mapping system in which, through the immediate synchrony index (imeSI), a graphical and mathematical processing of the signals originating from the variance of the DII leads (right IV septum) is performed and V6 (left ventricular lateral wall). For this, the software uses the measurement of the electric current flow (volume and direction) and the analysis of agreement of the intrinsicoid deflections of the QRS 6 .…”

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confidence: 99%

Advances in Physiological Cardiac Stimulation

Reis

Ferrari

Cabral

et al. 2021

J Cardiac Arrhtythmias

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Advances in cardiac stimulation demonstrate that bradyarrhythmia treatments go beyond heart rate control. The concern with the ventricular stimulation site and, consequently, with the maintenance of intraventricular synchrony has become routine in most services. Techniques of physiological cardiac stimulation, such as stimulation of the bundle of His and the left branch, have been improved. Despite the indisputable benefits of these therapeutic modalities, there are technical difficulties that limit systematic use. In this sense, to make physiological cardiac stimulation more practical and reproducible, the concept of parahissian stimulation was expanded and studied. The technique, simpler and reproducible, contemplates a conventional approach of the right ventricle. The big difference is the use of QRS spatial variance analysis technology (Synchromax®, Exo S.A., Argentina) to confirm the maintenance of ventricular synchrony according to the implanted site.

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confidence: 99%

Advances in Physiological Cardiac Stimulation

Reis

Ferrari

Cabral

et al. 2021

J Cardiac Arrhtythmias

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“…However, the identification of those patients who would respond favorably is still uncertain. Computer modeling has shown that the typical LBBB pattern can be a manifestation of slowed conduction velocity in the working myocardium, even when there is no block in the conduction system ( Bonomini et al, 2019 ). Therefore, exploring the correlation between QRS morphological changes and ventricular dyssynchrony can help construct new, noninvasive dyssynchrony biomarkers and provide new, reliable criterion to CRT.…”

Section: Discussionmentioning

confidence: 99%

“…Cardiac electrical dyssynchrony has gained increasing attention in the past decade as an endpoint in cardiac resynchronization therapy (CRT) ( Bonomini et al, 2019 ). However, many studies suggest that using QRS duration as the only criterion to detect dyssynchrony may have limitations.…”

Section: Introductionmentioning

confidence: 99%

“…A growing body of evidence supports the interventricular or intraventricular dyssynchrony, and not QRS duration, as the principal determinant of CRT outcome in nonspecific conduction diseased patients ( Bonomini et al, 2019 ). In this study, we developed a novel approach to the analysis of QRS morphology, termed as R-wave singularity (RWS), accompanied by a new statistical metric as the measurement of cardiac electrical dyssynchrony.…”

Section: Introductionmentioning

confidence: 99%

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R-Wave Singularity: A New Morphological Approach to the Analysis of Cardiac Electrical Dyssynchrony

Zhan

Shi

et al. 2020

Front. Physiol.

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R-wave singularity (RWS) measures the intermittence or discontinuousness of R waves. It has been broadly used in QRS (QRS complex of electrocardiogram) detection, electrocardiogram (ECG) beats classification, etc. In this article, we novelly developed RWS to the analysis of QRS morphology as the measurement of ventricular dyssynchrony and tested the hypothesis that RWS could enhance the discrimination between control and acute myocardial infarction (AMI) patients. Holter ECG recordings were obtained from the Telemetric and Holter ECG Warehouse database, among which database Normal was extracted as normal controls (n = 202) and database AMI (n = 93) as typical subjects of autonomic nervous system dysfunction and cardiac electrical dyssynchrony with high risk for cardiac arrhythmias and sudden cardiac death. Experimental results demonstrate that RWS measured by Lipschitz exponent calculated from 5-min Holter recordings was significantly less negative in early AMI and late AMI than that in Normal subjects for overall, elderly, and elderly male groups, which suggested the heterogeneous depolarization of the ventricular myocardium during AMI. Receiver operating characteristic curve analyses show that combined with heart rate variability parameters, Lipschitz exponent provides higher accuracy in distinguishing between the patients with AMI and healthy control subjects for overall, elderly, elderly male, and elderly female groups. In summary, our study demonstrates the significance of using RWS to probe the cardiac electrical dyssynchrony for AMI. Lipschitz exponent may be valuable and complementary for existing cardiac resynchronization therapy and autonomic nervous system assessment.

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“…By these means our method allows to measure the direction of intrinsic cardiac activation, electrical flow and coupling of the intrinsic deflections. Verification of capture of the conduction system and thus physiological pacing is simplified [3]. Synchromax ® ECG analysis allows us to confirm His-Purkinje system capture despite eventually a wider QRS.…”

mentioning

confidence: 99%

Non Selective his Bundle Pacing: As Physiological as S-HBP but Simpler and Faster

DF¹,

Logarzo²,

Paolucci³

et al. 2022

austinjclincardiolog

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We have read with interest Dr. Burri’s Electrocardiographic Analysis for His Bundle Pacing at Implantation and Follow up [1]. A comprehensive guide to understand electrocardiographic (ECG) nuances of His Bundle Pacing (HBP) is presented in this review. The authors, with outstanding didactics, describe a well-organized analysis of challenging HBP electrocardiographic characteristics to confirm conduction tissue (selective or non-selective HBP) at implant and follow-up. Caught our interest, in particular, the paragraph where practical pacing characteristics and benefits of non-selective HBP pacing (NSHBP) are emphasized. In this context we would like to point out the statement that pacing “ventricular myocardium adjacent to the atrioventricular septum, near the His bundle can also result in NSHBP”. Above all, of paramount clinical importance, when Dr. Burri et al. conclude that “No significant differences in cardiac mechanical synchrony or clinical outcome have been found between SHBP and NSHBP”. Our group is in total agreement with these essential features, having abandoned SHBP many years ago by developing a very simple technique to place standard pacing leads in the para-Hisian area (Figure 1). Concordant with the authors, we understand that “With non-selective His bundle pacing (NS-HBP), the lead is usually positioned in the ventricle at a site where the His bundle (HB) is surrounded by or at proximity to myocardial tissue”. That is why we named “para-Hisian pacing”. In our daily practice, at the same time, to verify and prove physiological capture of the conduction system we monitor synchrony online by analyzing the ECG signal variance [8] (Synchromax®) [2].

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Depolarization spatial variance as a cardiac dyssynchrony descriptor

Cited by 10 publications

References 21 publications

Advances in Physiological Cardiac Stimulation

Advances in Physiological Cardiac Stimulation

R-Wave Singularity: A New Morphological Approach to the Analysis of Cardiac Electrical Dyssynchrony

Non Selective his Bundle Pacing: As Physiological as S-HBP but Simpler and Faster

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