Left ventricle, LV wringing wall motion relies on physiological muscle fiber orientation, fibrotic status, and electromechanics (EM). The loss of proper EM activation can lead to rigid-body-type (RBT) LV rotation, which is associated with advanced heart failure (HF) and challenges in resynchronization. To describe the EM coupling and scar tissue burden with respect to rotational patterns observed on the LV in patients with ischemic heart failure with reduced ejection fraction (HFrEF) left bundle branch block (LBBB). Thirty patients with HFrEF/LBBB underwent EM analysis of the left ventricle using an invasive electro-mechanical catheter mapping system (NOGA XP, Biosense Webster). The following parameters were evaluated: rotation angle; rotation velocity; unipolar/bipolar voltage; local activation time, LAT; local electro-mechanical delay, LEMD; total electro-mechanical delay, TEMD. Patients underwent late-gadolinium enhancement cMRI when possible. The different LV rotation pattern served as sole parameter for patients' grouping into two categories: wringing rotation (Group A, n = 6) and RBT rotation (Group B, n = 24). All parameters were aggregated into a nine segment, three sector and whole LV models, and compared at multiple scales. Segmental statistical analysis in Group B revealed significant inhomogeneities, across the LV, regarding voltage level, scar burdening, and LEMD changes: correlation analysis showed correspondently a loss of synchronization between electrical (LAT) and mechanical activation (TEMD). On contrary, Group A (relatively low number of patients) did not present significant differences in LEMD across LV segments, therefore electrical (LAT) and mechanical (TEMD) activation were well synchronized. Fibrosis burden was in general associated with areas of low voltage. The rotational behavior of LV in HF/LBBB patients is determined by the local alteration of EM coupling. These findings serve as a strong basic groundwork for a hypothesis that EM analysis may predict CRT response.Clinical trial registration: SUM No. KNW/0022/KB1/17/15.

1st Department of Internal Medicine Cardioangiology St Anne's University Hospital in Brno Brno Czech Republic

Center for Computational Medicine in Cardiology Università Della Svizzera Italiana Lugano Switzerland

Department of Biochemistry and Molecular Biology Faculty of Health Sciences University of Bielsko Biala Bielsko Biała Poland

Department of Cardiology and Structural Heart Disease Medical University of Silesia Ziołowa 45 47 Katowice Poland

Department of Cardiothoracic and Vascular Surgery German Heart Center Berlin Berlin Germany

Department of Cardiovascular Surgery Charité Universitätsmedizin Berlin Berlin Germany

Department of Diagnostic Imaging Medical University of Silesia Katowice Poland

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

Department of Epidemiology Medical University of Silesia Katowice Poland

IHU LIRYC Inserm U1045 Bordeaux France

Institute for Regenerative Medicine University of Zurich Zurich Switzerland

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

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Electromechanical factors associated with favourable outcome in cardiac resynchronization therapy

Dyssynchronous Left Ventricular Activation is Insufficient for the Breakdown of Wringing Rotation