Transesophageal left ventricular electrogram-recording and temporary pacing to improve patient selection for cardiac resynchronization

Dannberg

Current Directions in Biomedical Engineering

et al. 2017

Self Cite

Cardiac resynchronization therapy with biventricular pacing is an established therapy for heart failure patients with sinus rhythm, reduced left ventricular ejection fraction and electrical ventricular desynchronization. The aim of the study was to evaluate electrical interventricular delay and left ventricular delay in right ventricular pacemaker pacing before upgrading to cardiac resynchronization therapy. Heart failure patients with right ventricular pacing, DDD pacemaker, DDD defibrillator and 24.5 ± 4.9 % left ventricular ejection fraction were measured by surface ECG and transesophageal bipolar left ventricular ECG before upgrading to cardiac resynchronization therapy. Interventricular and intraventricular desynchronization in right ventricular pacemaker pacing were 228.2 ± 44.8ms QRS duration, 86.5 ± 32.8ms interventricular delay and 94.4 ± 23.8ms left ventricular delay. Cardiac resynchronization therapy was optimized by impedance cardiography. Transesophageal electrical interventricular delay and left ventricular delay in right ventricular pacemaker pacing may be additional useful ventricular desynchronization parameters to improve patient selection for upgrading right ventricular pacemaker pacing to cardiac resynchronization therapy.

Section: Discussionmentioning

confidence: 97%

“…Transesophageal focused ECG allow the non-invasive evaluation of electrical interventricular delay [3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Electrical interventricular delay and left ventricular delay in right ventricular pacemaker pacing before upgrading to cardiac resynchronization therapy

Dannberg

Current Directions in Biomedical Engineering

et al. 2017

Self Cite

Biomedical Engineering / Biomedizinische Technik

“…The aim of this study was to evaluate electrical left atrial (LA) conduction delay, intra LA conduction delay, LV conduction delay and intra LV conduction delay in heart failure patients using novel signal averaging transesophageal left heart ECG software [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Signal averaging transesophageal left heart ECG software to evaluate left atrial conduction delay and left ventricular conduction delay in heart failure patients with dilated and ischaemic cardiomyopathy

Lorenz

Ismer

Straube³

et al. 2012

Self Cite

Cardiac resynchronization therapy with biventricular pacing is an established therapy for heart failure patients with electrical left ventricular desynchronization. The aim of this study was to evaluate left atrial conduction delay, intra left atrial conduction delay, left ventricular conduction delay and intra left ventricular conduction delay in heart failure patients using novel signal averaging transesophageal left heart ECG software. Methods: 8 heart failure patients with dilated cardiomyopathy (DCM), age 68 ± 9 years, New York Heart Association (NYHA) class 2.9 ± 0.2, 24.8 ± 6.7 % left ventricular ejection fraction, 188.8 ± 15.5 ms QRS duration and 8 heart failure patients with ischaemic cardiomyopathy (ICM), age 67 ± 8 years, NYHA class 2.9 ± 0.3, 32.5 ± 7.4 % left ventricular ejection fraction and 167.6 ± 19.4 ms QRS duration were analysed with transesophageal and transthoracic ECG by Bard LabDuo EP system and novel National Intruments LabView signal averaging ECG software. Results:The electrical left atrial conduction delay was 71.3 ± 17.6 ms in ICM versus 72.3 ± 12.4 ms in DCM, intra left atrial conduction delay 66.8 ± 8.6 ms in ICM versus 63.4 ± 10.9 ms in DCM and left cardiac AV delay 180.5 ± 32.6 ms in ICM versus 152.4 ± 30.4 ms in DCM. The electrical left ventricular conduction delay was 40.9 ± 7.5 ms in ICM versus 42.6 ± 17 ms in DCM and intra left ventricular conduction delay 105.6 ± 19.3 ms in ICM versus 128.3 ± 24.1 ms in DCM. Conclusions: Left heart signal averaging ECG can be utilized to analyse left atrial conduction delay, intra left atrial conduction delay, left ventricular conduction delay and intra left ventricular conduction delay to improve patient selection for cardiac resynchronization therapy.

“…The aim of this study was to evaluate left atrial (LA) conduction delay and left ventricular (LV) conduction delay using pre-implantational transesophageal electrocardiography (ECG) in sinus rhythm cardiac resynchronization therapy responder and non-responder [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Left atrial and left ventricular conduction delay by transesophageal electrocardiography with hemispherical electrodes in sinus rhythm cardiac resynchronization therapy

Biomedical Engineering / Biomedizinische Technik

Ismer

Kuehnert

et al. 2012

Self Cite

Cardiac resynchronization therapy (CRT) with biventricular (BV) pacing is an established therapy in approximately twothirds of symptomatic heart failure (HF) patients (P) with left bundle branch block (LBBB). The aim of this study was to evaluate left atrial (LA) conduction delay (LACD) and left ventricular (LV) conduction delay (LVCD) using preimplantational transesophageal electrocardiography (ECG) in sinus rhythm (SR) CRT responder (R) and non-responder (NR). Methods: SR HF P (n=52, age 63.6±10.4 years; 6 females, 46 males) with New York Heart Association (NYHA) class 3.0±0.2, 24.4±7.1 % LV ejection fraction and 171.2±37.6 ms QRS duration (QRSD) were measured by bipolar filtered transesophageal LA and LV ECG recording with hemispherical electrodes (HE) TO catheter (Osypka AG, Rheinfelden, Germany). LACD was measured between onset of P-wave in the surface ECG and onset of LA deflection in the LA ECG. LVCD was measured between onset of QRS in the surface ECG and onset of LV deflection in the LV ECG. Results: There were 78.8 % SR CRT R (n=41) with 171.2±36.9 ms QRSD, 73.3±25.7 ms LACD, 80.0±24.0 ms LVCD and 2.3±0.5 QRSD-LVCD-ratio. SR CRT R QRSD correlated with LACD (r=0.688, P<0.001) and LVCD (r=0.699, P<0.001). There were 21.2 % SR CRT NR (n=11) with 153.4±22.4 ms QRSD (P=0.133), 69.8±24.8 ms LACD (n=6, P=0.767), 54.2±31.0 ms LVCD (P<0.0046) and 3.9±2.5 QRSD-LVCD-ratio (P<0.001). SR CRT NR QRSD not correlated with IACD (r=-0.218, P=0.678) and IVCD (r=0.042, P=0.903). During a 22.8±21.3 month CRT follow-up, the CRT R NYHA class improved from 3.1±0.3 to 1.9±0.3 (P<0.001). In CRT NR, NYHA class not improved (2.9±0.4 to 2.9±0.2, P=1) during 11.2±9.8 months BV pacing. Conclusions: Transesophageal LA and LV ECG with HE can be utilized to analyse LACD and LVCD in HF P. Preimplantational LVCD and QRSD-LVCD-ratio may be additional useful parameters to improve P selection for SR CRT. IntroductionCardiac resynchronization therapy with biventricular (BV) pacing is an established therapy in approximately twothirds of symptomatic heart failure patients with left bundle branch block. The aim of this study was to evaluate left atrial (LA) conduction delay and left ventricular (LV) conduction delay using pre-implantational transesophageal electrocardiography (ECG) in sinus rhythm cardiac resynchronization therapy responder and non-responder [1-4]. MethodsHeart failure patients with sinus rhythm (n=52, age 63.6±10.4 years; 6 females, 46 males) with New York Heart Association (NYHA) class 3.0±0.2, 24.4±7.1 % LV ejection fraction and 171.2±37.6 ms QRS duration were measured by bipolar filtered transesophageal LA and LV ECG recording with hemispherical electrodes TO catheter with distal 10 mm cylindrical electrode and three (TO4 catheter) or seven 6 mm hemispherical electrodes (TO8 catheter) with 15 mm electrode distance (TO, Osypka AG, Rheinfelden, Germany) (Fig. 1).The TO8 catheter proximal 4 LA electrodes were placed in a LA level of the esophagus in position of maximum LA potential and the TO8 catheter distal 4 LV elec...