AIMS: The aim of this study was to determine the relationship between electrical and mechanical activation in heart failure (HF) patients and whether electromechanical coupling is affected by scar. METHODS AND RESULTS: Seventy HF patients referred for cardiac resynchronization therapy or biological therapy underwent endocardial anatomo-electromechanical mapping (AEMM) and delayed-enhancement magnetic resonance (CMR) scans. Area strain and activation times were derived from AEMM data, allowing to correlate mechanical and electrical activation in time and space with unprecedented accuracy. Special attention was paid to the effect of presence of CMR-evidenced scar. Patients were divided into a scar (n = 43) and a non-scar group (n-27). Correlation between time of electrical and mechanical activation was stronger in the non-scar compared to the scar group [R = 0.84 (0.72-0.89) vs. 0.74 (0.52-0.88), respectively; P = 0.01]. The overlap between latest electrical and mechanical activation areas was larger in the absence than in presence of scar [72% (54-81) vs. 56% (36-73), respectively; P = 0.02], with smaller distance between the centroids of the two regions [10.7 (4.9-17.4) vs. 20.3 (6.9-29.4) % of left ventricular radius, P = 0.02]. CONCLUSION: Scar decreases the association between electrical and mechanical activation, even when scar is remote from late activated regions.

Center for Computational Medicine in Cardiology Università della Svizzera italiana Via G Buffi 13 CH 6900 Lugano Switzerland

Department of Electrocardiology and Heart Failure Medical University of Silesia Katowice Poland

Department of Physiology CARIM Maastricht University Maastricht The Netherlands

Division of Cardiology and Structural Heart Diseases Medical University of Silesia Katowice Poland

Division of Cardiology Fondazione Cardiocentro Ticino Lugano Switzerland

Interventional Cardiac Electrophysiology Group International Clinical Research Center St Anne's University Hospital Brno Czech Republic

Europace. 2020 May 1;22(5):786. doi: 10.1093/europace/euaa033. PubMed

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