• Publikační typ
• abstrakt z konference MeSH

AIMS: The standard deviation of activation time (SDAT) derived from body surface maps (BSMs) has been proposed as an optimal measure of electrical dyssynchrony in patients with cardiac resynchronization therapy (CRT). The goal of this study was two-fold: (i) to compare the values of SDAT in individual CRT patients with reconstructed myocardial metrics of depolarization heterogeneity using an inverse solution algorithm and (ii) to compare SDAT calculated from 96-lead BSM with a clinically easily applicable 12-lead electrocardiogram (ECG). METHODS AND RESULTS: Cardiac resynchronization therapy patients with sinus rhythm and left bundle branch block at baseline (n = 19, 58% males, age 60 ± 11 years, New York Heart Association Classes II and III, QRS 167 ± 16) were studied using a 96-lead BSM. The activation time (AT) was automatically detected for each ECG lead, and SDAT was calculated using either 96 leads or standard 12 leads. Standard deviation of activation time was assessed in sinus rhythm and during six different pacing modes, including atrial pacing, sequential left or right ventricular, and biventricular pacing. Changes in SDAT calculated both from BSM and from 12-lead ECG corresponded to changes in reconstructed myocardial ATs. A high degree of reliability was found between SDAT values obtained from 12-lead ECG and BSM for different pacing modes, and the intraclass correlation coefficient varied between 0.78 and 0.96 (P < 0.001). CONCLUSION: Standard deviation of activation time measurement from BSM correlated with reconstructed myocardial ATs, supporting its utility in the assessment of electrical dyssynchrony in CRT. Importantly, 12-lead ECG provided similar information as BSM. Further prospective studies are necessary to verify the clinical utility of SDAT from 12-lead ECG in larger patient cohorts, including those with ischaemic cardiomyopathy.

• MeSH
• elektrokardiografie MeSH
• lidé středního věku MeSH
• lidé MeSH
• prospektivní studie MeSH
• prostředky srdeční resynchronizační terapie MeSH
• reprodukovatelnost výsledků MeSH
• senioři MeSH
• srdeční arytmie terapie   MeSH
• srdeční resynchronizační terapie * metody   MeSH
• srdeční selhání * diagnóza   terapie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• defibrilátory implantabilní využití   MeSH
• elektrická defibrilace škodlivé účinky   využití   MeSH
• kvalita života MeSH
• lidé MeSH
• magnetická rezonanční tomografie využití   MeSH
• prognóza MeSH
• syndrom omráčeného myokardu diagnóza   MeSH
• Check Tag
• lidé MeSH

PURPOSE: The aim of this proof-of-concept study is to introduce new high-dynamic ECG technique with potential to detect temporal-spatial distribution of ventricular electrical depolarization and to assess the level of ventricular dyssynchrony. METHODS: 5-kHz 12-lead ECG data was collected. The amplitude envelopes of the QRS were computed in an ultra-high frequency band of 500-1000 Hz and were averaged (UHFQRS). UHFQRS V lead maps were compiled, and numerical descriptor identifying ventricular dyssynchrony (UHFDYS) was detected. RESULTS: An electrical UHFQRS maps describe the ventricular dyssynchrony distribution in resolution of milliseconds and correlate with strain rate results obtained by speckle tracking echocardiography. The effect of biventricular stimulation is demonstrated by the UHFQRS morphology and by the UHFDYS descriptor in selected examples. CONCLUSIONS: UHFQRS offers a new and simple technique for assessing electrical activation patterns in ventricular dyssynchrony with a temporal-spatial resolution that cannot be obtained by processing standard surface ECG. The main clinical potential of UHFQRS lies in the identification of differences in electrical activation among CRT candidates and detection of improvements in electrical synchrony in patients with biventricular pacing.

• MeSH
• dospělí MeSH
• dysfunkce levé srdeční komory diagnostické zobrazování   terapie   MeSH
• echokardiografie trojrozměrná metody   MeSH
• elektrokardiografie metody   MeSH
• interpretace obrazu počítačem * MeSH
• lidé středního věku MeSH
• lidé MeSH
• remodelace komor fyziologie   MeSH
• senioři MeSH
• srdeční resynchronizační terapie metody   MeSH
• stupeň závažnosti nemoci MeSH
• výsledek terapie MeSH
• vzorkové studie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

K dyssynchrónnym kontrakciám srdca dochádza ak sa určitá oblasť steny myokardu kontrahuje neskôr ako ostatné oblasti. Vzniká následkom oneskoreného elektrického vedenia, najčastejšie vplyvom blokády ľavého Tawarovho ramienka. Dyssynchrónia redukuje efektívnosť práce srdca ako aj jeho čerpaciu funkciu. Resynchronizačná liečba vedie u pacientov v štádiu chronického srdcového zlyhávania k významnému zlepšeniu výkonu srdca vplyvom časového zosúladenia kontrakcií.

Cardiac dyssynchrony occurs when one portion of the wall contracts later than others. It is the consequence of electrical conduction delay, mostly caused by left bundle branch block. Dyssynchrony reduces both global pump function and heart efficiency. Cardiac resynchronization therapy results in substantial improvement in acute and long-term left ventricular performance of patients with chronic heart failure by retiming of contractions of dyssynchronous ventricular wall segments.

Východisko. U pacientů s chronickou atrioventrikulární blokádou (AVB) nebo prostou komorovou kardiostimulací (VVI) a zachovanou sinusovou depolarizací jsou levá a pravá předsíň (LA, RA) přetížené zvýšeným intraatriálním tlakem způsobeným atrioventrikulární dyssynchronií (AVDys). Přetížené síně mohou dilatovat a ztratit svou kontraktilní funkci. Cílem práce bylo zjistit vztah mezi intrakardiálně měřeným tlakem a dilatací předsíní u pacientů s AVDys a současně také ověřit, zda případná dilatace pravé předsíně u těchto pacientů souvisí s nižším elektrickým potenciálem pravé síně. Metody. U 26 pacientů (77 ± 10 let, 16 mužů), kde dlouhodobá AVDys byla hlavním patofyziologickým mechanismem vedoucím k přetížení síní (12 AVB, 14 VVI), byly změřeny intrakardiální tlaky (žilní, pravokomorový, plicní arteriální a zaklíněný – PWP) a elektrické potenciály v pravé síni. Tyto veličiny korelovaly s echokardiograficky získanými parametry (rozměry, objemy a ejekční frakce levé a pravé síně). Výsledky. Ejekční frakce LA a PWP vykazovaly středně silnou inversní korelaci: r = –0,489, p = 0,025, hladina významnosti 0,05. Souvislost PWP a morfologických ukazatelů LA nebyla potvrzena. Nebyly nalezeny významné korelace mezi intraatriálním potenciálem RA a její morfologií či funkcí. Ani pravostranné tlaky nekorelovaly s echokardiografickými ukazateli. Závěry. Ve studovaném souboru byla nalezena inverzní korelace mezi zaklíněným tlakem a ejekční frakcí levé síně, nepodařilo se však prokázat jinou korelaci morfologických a funkčních parametrů předsíní měřených echokardiograficky s intrakardiálním tlakem ani elektrickým potenciálem.

Background: In pts with chronic complete heart block or single chamber pacing and preserved sinus depolarization, left and right atria (LA, RA) may suffer from increased intraatrial pressure resulting from atrioventricular dyssynchrony (AVDys), dilate and lose their contractile function. Purpose: To find out whether any correlation exists between the echocardiographicaly measured LA, RA morphological and functional parameters on one hand and the intracardiac RA pressures and electrical potentials on the other hand in patients with chronic AVDys. Methods: In 26 pts (77 ±10 yrs., 16 males), where a chronic AVDys was the most important patophysiological mechanism of atrial overloading, the intraatrial pressures (atrial, right ventricular, pulmonary arterial and wedge pressure /PWP/) and electrical potentials (upper, middle, lower part of RA and RA appendage) were correlated with atrial diameters, volumes, ejection fraction and filling parameters. Results: There was a moderate inverse correlation between the LA ejection fraction and PWP: r = - 0,489, p = 0,025 at a level of significance 0.05), but no relationship between PWP and LA size/volumes. No correlation between RA potentials or intracardiac pressures and RA morphologic or functional features were documented. Conclusions: In this study, an inverse correlation between the capillary wedge pressure and left atrial ejection fraction in pts with chronic atrioventricular dyssynchrony was documented.

• Klíčová slova
• předsíně, morfologie, intrakardiální tlak,
• MeSH
• atrioventrikulární blokáda patofyziologie   MeSH
• dilatace patologická MeSH
• echokardiografie statistika a číselné údaje   MeSH
• hemodynamika fyziologie   MeSH
• kardiostimulace umělá MeSH
• krevní tlak MeSH
• lidé MeSH
• membránové potenciály MeSH
• senioři MeSH
• srdce - funkce síní MeSH
• srdeční síně patofyziologie   patologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH

BACKGROUND: Nonselective His-bundle pacing (nsHBp), nonselective left bundle branch pacing (nsLBBp), and left ventricular septal myocardial pacing (LVSP) are recognized as physiological pacing techniques. OBJECTIVE: The purpose of this study was to compare differences in ventricular depolarization between these techniques using ultra-high-frequency electrocardiography (UHF-ECG). METHODS: In patients with bradycardia, nsHBp, nsLBBp (confirmed concomitant left bundle branch [LBB] and myocardial capture), and LVSP (pacing in left ventricular [LV] septal position without proven LBB capture) were performed. Timings of ventricular activations in precordial leads were displayed using UHF-ECG, and electrical dyssynchrony (e-DYS) was calculated as the difference between the first and last activation. Duration of local depolarization (Vd) was determined as width of the UHF-QRS complex at 50% of its amplitude. RESULTS: In 68 patients, data were collected during nsLBBp (35), LVSP (96), and nsHBp (55). nsLBBp resulted in larger e-DYS than did LVSP and nsHBp [- 24 ms (-28;-19) vs -12 ms (-16;-9) vs 10 ms (7;14), respectively; P <.001]. nsLBBp produced similar values of Vd in leads V5-V8 (36-43 ms vs 38-43 ms; P = NS in all leads) but longer Vd in leads V1-V4 (47-59 ms vs 41-44 ms; P <.05) as nsHBp. LVSP caused prolonged Vd in leads V1-V8 compared to nsHBp and longer Vd in leads V5-V8 compared to nsLBBp (44-51 ms vs 36-43 ms; P <.05) regardless of R-wave peak time in lead V5 or QRS morphology in lead V1 present during LVSP. CONCLUSION: nslbbp preserves physiological LV depolarization but increases interventricular electrical dyssynchrony. LV lateral wall depolarization during LVSP is prolonged, but interventricular synchrony is preserved.

• MeSH
• blokáda Tawarova raménka patofyziologie   terapie   MeSH
• elektrokardiografie metody   MeSH
• funkce levé komory srdeční fyziologie   MeSH
• Hisův svazek patofyziologie   MeSH
• kardiostimulace umělá metody   MeSH
• lidé MeSH
• mezikomorová přepážka patofyziologie   MeSH
• následné studie MeSH
• prospektivní studie MeSH
• senioři MeSH
• srdeční komory patofyziologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH

From precordial ECG leads, the conventional determination of the negative derivative of the QRS complex (ND-ECG) assesses epicardial activation. Recently we showed that ultra-high-frequency electrocardiography (UHF-ECG) determines the activation of a larger volume of the ventricular wall. We aimed to combine these two methods to investigate the potential of volumetric and epicardial ventricular activation assessment and thereby determine the transmural activation sequence. We retrospectively analyzed 390 ECG records divided into three groups-healthy subjects with normal ECG, left bundle branch block (LBBB), and right bundle branch block (RBBB) patients. Then we created UHF-ECG and ND-ECG-derived depolarization maps and computed interventricular electrical dyssynchrony. Characteristic spatio-temporal differences were found between the volumetric UHF-ECG activation patterns and epicardial ND-ECG in the Normal, LBBB, and RBBB groups, despite the overall high correlations between both methods. Interventricular electrical dyssynchrony values assessed by the ND-ECG were consistently larger than values computed by the UHF-ECG method. Noninvasively obtained UHF-ECG and ND-ECG analyses describe different ventricular dyssynchrony and the general course of ventricular depolarization. Combining both methods based on standard 12-lead ECG electrode positions allows for a more detailed analysis of volumetric and epicardial ventricular electrical activation, including the assessment of the depolarization wave direction propagation in ventricles.

• MeSH
• blokáda Tawarova raménka diagnóza   MeSH
• elektrokardiografie * metody   MeSH
• lidé MeSH
• retrospektivní studie MeSH
• srdeční arytmie MeSH
• srdeční komory * diagnostické zobrazování   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH

INTRODUCTION: Left bundle branch area pacing (LBBAP) comprises pacing at the left ventricular septum (LVSP) or left bundle branch (LBBP). The aim of the present study was to investigate the differences in ventricular electrical heterogeneity between LVSP, LBBP, right ventricular pacing (RVP) and intrinsic conduction with different dyssynchrony measures using the ECG, vectorcardiograpy, ECG belt, and Ultrahigh frequency (UHF-)ECG. METHODS: Thirty-seven patients with a pacemaker indication for bradycardia or cardiac resynchronization therapy underwent LBBAP implantation. ECG, vectorcardiogram, ECG belt and UHF-ECG signals were recorded during RVP, LVSP and LBBP, and intrinsic activation. QRS duration (QRSd) was measured from the ECG, QRS area was calculated from the vectorcardiogram, LV activation time (LVAT) and standard deviation of activation time (SDAT) from ECG belt and electrical dyssynchrony (e-DYS16) from UHF-ECG. RESULTS: Both LVSP and LBBP significantly reduced ventricular electrical heterogeneity as compared to underlying LBBB and RV pacing in terms of QRS area (p < .001), SDAT (p < .001), LVAT (p < .001) and e-DYS16 (p < .001). QRSd was only reduced as compared to RV pacing(p < .001). QRS area was similar during LBBP and normal intrinsic conduction, e-DYS16 was similar during LVSP and normal intrinsic conduction, whereas SDAT was similar for LVSP, LBBP and normal intrinsic conduction. For all these variables there was no significant difference between LVSP and LBBP. CONCLUSION: Both LVSP and LBBP resulted in a more synchronous LV activation than LBBB and RVP. Especially LBBP resulted in levels of LV synchrony comparable to normal intrinsic conduction.

• MeSH
• akční potenciály * MeSH
• blokáda Tawarova raménka patofyziologie   terapie   diagnóza   MeSH
• bradykardie patofyziologie   terapie   diagnóza   MeSH
• časové faktory MeSH
• elektrofyziologické techniky kardiologické MeSH
• elektrokardiografie MeSH
• funkce levé komory srdeční * MeSH
• Hisův svazek * patofyziologie   MeSH
• kardiostimulace umělá * MeSH
• lidé středního věku MeSH
• lidé MeSH
• mezikomorová přepážka * patofyziologie   MeSH
• prediktivní hodnota testů * MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• srdeční frekvence * MeSH
• srdeční resynchronizační terapie MeSH
• vektorkardiografie * metody   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• srovnávací studie MeSH

BACKGROUND: Right ventricular myocardial pacing leads to nonphysiological activation of heart ventricles. Contrary to this, His bundle pacing preserves their fast activation. Ultra-high-frequency electrocardiography (UHF-ECG) is a novel tool for ventricular depolarization assessment. OBJECTIVE: The purpose of this study was to describe UHF-ECG depolarization patterns during myocardial and His bundle pacing. METHODS: Forty-six patients undergoing His bundle pacing to treat bradycardia and spontaneous QRS complexes without bundle branch block were included. UHF-ECG recordings were performed during spontaneous rhythm, pure myocardial para-Hisian capture, and His bundle capture. QRS duration, QRS area, depolarization time in specific leads, and the UHF-ECG-derived ventricular dyssynchrony index were calculated. RESULTS: One hundred thirty-three UHF-ECG recordings were performed in 46 patients (44 spontaneous rhythm, 28 selective His bundle, 43 nonselective His bundle, and 18 myocardial capture). The mean QRS duration was 117 ms for spontaneous rhythm, 118 ms for selective, 135 ms for nonselective, and 166 ms for myocardial capture (P < .001 for nonselective and myocardial capture compared to each of the other types of ventricular activation). The calculated dyssynchrony index was shortest during spontaneous rhythm (12 ms; P = .02 compared to selective and P = .09 compared to nonselective), and it did not differ between selective and nonselective His bundle capture (16 vs 15 ms; P > .99) and was longest during myocardial capture of the para-Hisian area (37 ms; P < .001 compared to each of the other types of ventricular activation). CONCLUSION: In patients without bundle branch block, both types of His bundle, but not myocardial, capture preserve ventricular electrical synchrony as measured using UHF-ECG.

• MeSH
• blokáda Tawarova raménka patofyziologie   terapie   MeSH
• elektrokardiografie metody   MeSH
• funkce levé komory srdeční fyziologie   MeSH
• funkce pravé komory srdeční fyziologie   MeSH
• Hisův svazek patofyziologie   MeSH
• kardiostimulace umělá metody   MeSH
• lidé MeSH
• senioři MeSH
• srdeční frekvence fyziologie   MeSH
• srdeční komory patofyziologie   MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH