Heart ventricular activation in VAT difference maps from children with chronic kidney disease

Abstract

Children with chronic kidney disease (CKD) are affected by cardiovascular complications, including disturbances in the intraventricular conduction system. Body surface potential mapping (BSPM) is a non-invasive method of assessing the cardioelectrical field. Our aim was to investigate conduction disturbances in young CKD patients using ventricular activation time (VAT) maps. Our study comprised 22 CKD children (mean age: 13.1 ± 2.5 years) treated conservatively and 29 control patients. For each child 12-lead electrocardiogram (ECG) readings were taken, and blood pressure and serum concentrations of iPTH, Pi, t-Ca, creatinine, Fe+3, ferritin, and Hb, as well as eGFR were measured. All children underwent registration in the 87-lead BSPM system, and group-mean VAT maps and a difference map, which presents statistically significant differences between the groups, were created. The VAT map distribution in CKD patients revealed abnormalities specific to left anterior fascicle block. The difference map displays the areas of intergroup VAT changes, which are of discriminative value in detecting intraventricular conduction disturbances. Intraventricular conduction impairments in the left bundle branch may occur in children with CKD. BSPM enables conduction disturbances in CKD children to be detected earlier than using 12-lead ECG. The difference map derived from the group-mean isochrone maps precisely localizes the sites of disturbed conduction in the heart intraventricular conduction system.

Effects of hemodialysis on ventricular activation time in children with end‐stage renal disease

“…It should be noted that in the examined patients with ESRD, there were no diagnostic findings in the standard 12‐lead ECGs, being indicative of either LBBB or LAFB. The presented results are compliant with our previous observations showing usefulness of the BSPM method in identifying initial heart conduction impairments in children with CKD …”

“…As a result of a single HD session, in the examined patients with ESRD, the above‐mentioned abnormalities on VAT maps were modified indicating some improvement in activation transmission through the intraventricular conduction pathway. However, it should simultaneously be noted that the longer is the overall HD treatment duration, the more significant and permanent pathology is observed in the heart conduction system, not susceptible to normalization after HD procedure …”

“…Cardiovascular disturbances, called the cardiorenal syndrome, are considered the most common fatal complications in the course of ESRD . A similar danger affects young patients with ESRD, in whom the cardiorenal syndrome is a growing cause of hospitalization.…”

Dynamics of Changes in Heart Conduction System in Dialyzed Young Adults After Kidney Transplantation—Pilot Study

“…The electrodes were mounted on flexible disposable tapes on the anterior and posterior chest with the patient in recumbent position. The method of body surface mapping allows for synchronic recording of electric signals from the multielectrode system, which are then graphically plotted as various kinds of map [5,9].…”

“…Isochrone maps are of particular importance in this context, as they accurately illustrate the pathways and time of impulse spreading in the heart [5e7]. Their usefulness in depicting cardiac changes has been confirmed by various researchers, in both adult and pediatric populations, including those affected by CKD [8,9].…”