Cardiac resynchronization therapy (CRT) has become standard therapy for selected patients with congestive heart failure and dyssynchrony of cardiac contraction that is a consequence of electrical dyssynchrony. Intracardiac mapping enables detailed analysis of electrical activation sequences far beyond the standard ECG and allows description of specific activation associated with the benefit of CRT. Intracardiac mapping can also localize the region of the latest ventricular activation and areas of slow conduction, and thus potentially assist in selection of optimal pacing site for CRT. Precise description of electrical activation sequences, and correlation with parameters of mechanical dyssynchrony, may contribute to understanding the principles and mechanisms underlying the effect of CRT.
Cardiac resynchronization therapy (CRT) has proven efficacious in the treatment of patients with heart failure and dyssynchronous activation. Currently, we select suitable CRT candidates based on the QRS complex duration (QRSd) and morphology with left bundle branch block being the optimal substrate for resynchronization. To improve CRT response rates, recommendations emphasize attention to electrical parameters both before implant and after it. Therefore, we decided to study activation times before and after CRT on the body surface potential maps (BSPM) and to compare thus obtained results with data from electroanatomical mapping using the CARTO system. Total of 21 CRT recipients with symptomatic heart failure (NYHA II-IV), sinus rhythm, and QRSd >/=150 ms and 7 healthy controls were studied. The maximum QRSd and the longest and shortest activation times (ATmax and ATmin) were set in the BSPM maps and their locations on the chest were compared with CARTO derived time interval and site of the latest (LATmax) and earliest (LATmin) ventricular activation. In CRT patients, all these parameters were measured during both spontaneous rhythm and biventricular pacing (BVP) and compared with the findings during the spontaneous sinus rhythm in the healthy controls. QRSd was 169.7+/-12.1 ms during spontaneous rhythm in the CRT group and 104.3+/-10.2 ms after CRT (p<0.01). In the control group the QRSd was significantly shorter: 95.1+/-5.6 ms (p<0.01). There was a good correlation between LATmin(CARTO) and ATmin(BSPM). Both LATmin and ATmin were shorter in the control group (LATmin(CARTO) 24.8+/-7.1 ms and ATmin(BSPM) 29.6+/-11.3 ms, NS) than in CRT group (LATmin(CARTO) was 48.1+/-6.8 ms and ATmin(BSPM) 51.6+/-10.1 ms, NS). BVP produced shortening compared to the spontaneous rhythm of CRT recipients (LATmin(CARTO) 31.6+/-5.3 ms and ATmin(BSPM) 35.2+/-12.6 ms; p<0.01 spontaneous rhythm versus BVP). ATmax exhibited greater differences between both methods with higher values in BSPM: in the control group LATmax(CARTO) was 72.0+/-4.1 ms and ATmax (BSPM) 92.5+/-9.4 ms (p<0.01), in the CRT candidates LATmax(CARTO) reached only 106.1+/-6.8 ms whereas ATmax(BSPM) 146.0+/-12.1 ms (p<0.05), and BVP paced rhythm in CRT group produced improvement with LATmax(CARTO) 92.2+/-7.1 ms and ATmax(BSPM) 130.9+/-11.0 ms (p<0.01 before and during BVP). With regard to the propagation of ATmin and ATmax on the body surface, earliest activation projected most often frontally in all 3 groups, whereas projection of ATmax on the body surface was more variable. Our results suggest that compared to invasive electroanatomical mapping BSPM reflects well time of the earliest activation, however provides longer time-intervals for sites of late activation. Projection of both early and late activated regions of the heart on the body surface is more variable than expected, very likely due to changed LV geometry and interposed tissues between the heart and superficial ECG electrode.
- MeSH
- Bundle-Branch Block diagnosis physiopathology therapy MeSH
- Adult MeSH
- Electrophysiological Phenomena physiology MeSH
- Electrocardiography methods trends MeSH
- Middle Aged MeSH
- Humans MeSH
- Body Surface Potential Mapping methods trends MeSH
- Heart Conduction System physiopathology MeSH
- Aged MeSH
- Cardiac Resynchronization Therapy methods trends MeSH
- Heart Failure diagnosis physiopathology therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: The left ventricular (LV) lead local electrogram (EGM) delay from the beginning of the QRS complex (QLV) is considered a strong predictor of response to cardiac resynchronization therapy. We have developed a method for fast epicardial QLV mapping during video-thoracoscopic surgery to guide LV lead placement. METHODS: A three-port, video-thoracoscopic approach was used for LV free wall epicardial mapping and lead implantation. A decapolar electrophysiological catheter was introduced through one port and systematically attached to multiple accessible LV sites. The pacing lead was targeted to the site with maximum QLV. The LV free wall activation pattern was analyzed in 16 pre-specified anatomical segments. RESULTS: We implanted LV leads in 13 patients with LBBB or IVCD. The procedural and mapping times were 142 ± 39 minutes and 20 ± 9 minutes, respectively. A total of 15.0 ± 2.2 LV segments were mappable with variable spatial distribution of QLV-optimum. The QLV ratio (QLV/QRSd) at the optimum segment was significantly higher (by 0.17 ± 0.08, p < 0.00001) as compared to an empirical midventricular lateral segment. The LV lead was implanted at the optimum segment in 11 patients (at an adjacent segment in 2 patients) achieving a QLV ratio of 0.82 ± 0.09 (range 0.63-0.93) and 99.5 ± 0.6% match with intraprocedural mapping. CONCLUSION: Video-thoracoscopic LV lead implantation can be effectively and safely guided by epicardial QLV mapping. This strategy was highly successful in targeting the selected LV segment and resulted in significantly higher QLV ratios compared to an empirical midventricular lateral segment.
- MeSH
- Bundle-Branch Block diagnosis physiopathology therapy MeSH
- Time Factors MeSH
- Equipment Design MeSH
- Epicardial Mapping * MeSH
- Ventricular Function, Left MeSH
- Thoracic Surgery, Video-Assisted * MeSH
- Ventricular Pressure MeSH
- Middle Aged MeSH
- Humans MeSH
- Pericardium physiopathology MeSH
- Predictive Value of Tests MeSH
- Cardiac Resynchronization Therapy Devices * MeSH
- Aged MeSH
- Heart Ventricles physiopathology surgery MeSH
- Cardiac Resynchronization Therapy * adverse effects MeSH
- Feasibility Studies MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Evaluation Study MeSH
BACKGROUND AND OBJECTIVES: Catheter ablation of ventricular tachycardia (VT) may include induction of VT and localization of VT-exit site. Our aim was to assess localization performance of a novel statistical pace-mapping method and compare it with performance of an electrocardiographic inverse solution. METHODS: Seven patients undergoing ablation of VT (4 with epicardial, 3 with endocardial exit) aided by electroanatomic mapping underwent intraprocedural 120-lead body-surface potential mapping (BSPM). Two approaches to localization of activation origin were tested: (1) A statistical method, based on multiple linear regression (MLR), which required only the conventional 12-lead ECG for a sufficient number of pacing sites with known origin together with patient-specific geometry of the endocardial/epicardial surface obtained by electroanatomic mapping; and (2) a classical deterministic inverse solution for recovering heart-surface potentials, which required BSPM and patient-specific geometry of the heart and torso obtained via computed tomography (CT). RESULTS: For the MLR method, at least 10-15 pacing sites with known coordinates, together with their corresponding 12-lead ECGs, were required to derive reliable patient-specific regression equations, which then enabled accurate localization of ventricular activation with unknown origin. For 4 patients who underwent epicardial mapping, the median of localization error for the MLR was significantly lower than that for the inverse solution (10.6 vs. 27.3 mm, P = 0.034); a similar result held for 3 patients who underwent endocardial mapping (7.7 vs. 17.1 mm, P = 0.017). The pooled localization error for all epicardial and endocardial sites was also significantly smaller for the MLR compared with the inverse solution (P = 0.005). CONCLUSIONS: The novel pace-mapping approach to localizing the origin of ventricular activation offers an easily implementable supplement and/or alternative to the preprocedure inverse solution; its simplicity makes it suitable for real-time applications during clinical catheter-ablation procedures.
- MeSH
- Models, Anatomic MeSH
- Catheter Ablation methods MeSH
- Tachycardia, Ventricular diagnostic imaging physiopathology surgery MeSH
- Humans MeSH
- Body Surface Potential Mapping instrumentation methods MeSH
- Models, Cardiovascular * MeSH
- Imaging, Three-Dimensional instrumentation methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
Hippocampal place cells represent different environments with distinct neural activity patterns. Following an abrupt switch between two familiar configurations of visual cues defining two environments, the hippocampal neural activity pattern switches almost immediately to the corresponding representation. Surprisingly, during a transient period following the switch to the new environment, occasional fast transitions between the two activity patterns (flickering) were observed (Jezek, Henriksen, Treves, Moser, & Moser, ). Here we show that an attractor neural network model of place cells with connections endowed with short-term synaptic plasticity can account for this phenomenon. A memory trace of the recent history of network activity is maintained in the state of the synapses, allowing the network to temporarily reactivate the representation of the previous environment in the absence of the corresponding sensory cues. The model predicts that the number of flickering events depends on the amplitude of the ongoing theta rhythm and the distance between the current position of the animal and its position at the time of cue switching. We test these predictions with new analysis of experimental data. These results suggest a potential role of short-term synaptic plasticity in recruiting the activity of different cell assemblies and in shaping hippocampal activity of behaving animals.
- MeSH
- Action Potentials physiology MeSH
- Time Factors MeSH
- Electroencephalography MeSH
- Hippocampus cytology MeSH
- Rats MeSH
- Brain Mapping MeSH
- Models, Neurological * MeSH
- Nerve Net physiology MeSH
- Neurons physiology MeSH
- Neuronal Plasticity physiology MeSH
- Cues MeSH
- Spatial Memory physiology MeSH
- Photic Stimulation MeSH
- Theta Rhythm physiology MeSH
- Animals MeSH
- Check Tag
- Rats MeSH
- Animals MeSH
- Publication type
- Journal Article MeSH
Thoughts on how randomly induced noise can be detected in BSPM processing.
- MeSH
- Differential Threshold MeSH
- Electrodiagnosis methods MeSH
- Electric Stimulation Therapy methods MeSH
- Fourier Analysis MeSH
- Noise MeSH
- Humans MeSH
- Body Surface Potential Mapping * methods MeSH
- Cardiac Resynchronization Therapy methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
The EU Horizon 2020 Framework-funded Standardized Treatment and Outcome Platform for Stereotactic Therapy Of Re-entrant tachycardia by a Multidisciplinary (STOPSTORM) consortium has been established as a large research network for investigating STereotactic Arrhythmia Radioablation (STAR) for ventricular tachycardia (VT). The aim is to provide a pooled treatment database to evaluate patterns of practice and outcomes of STAR and finally to harmonize STAR within Europe. The consortium comprises 31 clinical and research institutions. The project is divided into nine work packages (WPs): (i) observational cohort; (ii) standardization and harmonization of target delineation; (iii) harmonized prospective cohort; (iv) quality assurance (QA); (v) analysis and evaluation; (vi, ix) ethics and regulations; and (vii, viii) project coordination and dissemination. To provide a review of current clinical STAR practice in Europe, a comprehensive questionnaire was performed at project start. The STOPSTORM Institutions' experience in VT catheter ablation (83% ≥ 20 ann.) and stereotactic body radiotherapy (59% > 200 ann.) was adequate, and 84 STAR treatments were performed until project launch, while 8/22 centres already recruited VT patients in national clinical trials. The majority currently base their target definition on mapping during VT (96%) and/or pace mapping (75%), reduced voltage areas (63%), or late ventricular potentials (75%) during sinus rhythm. The majority currently apply a single-fraction dose of 25 Gy while planning techniques and dose prescription methods vary greatly. The current clinical STAR practice in the STOPSTORM consortium highlights potential areas of optimization and harmonization for substrate mapping, target delineation, motion management, dosimetry, and QA, which will be addressed in the various WPs.
- MeSH
- Catheter Ablation * adverse effects methods MeSH
- Tachycardia, Ventricular * MeSH
- Humans MeSH
- Prospective Studies MeSH
- Arrhythmias, Cardiac MeSH
- Heart Ventricles MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Review MeSH
Implantace trvalé kardiostimulace patří k výkonům, které se provádí v průběhu krátkodobé hospitalizace. Cílem práce byla identifikace nejčastějších ošetřovatelských intervencí/potřeb pacientů indikovaných k zavedení trvalé kardiostimulace v průběhu krátkodobé hospitalizace a následné vytvoření komplexní ošetřovatelské mapy péče. Prostřednictvím retrospektivní analýzy zdravotnické dokumentace byla sumarizována data od 100 pacientů, kteří byli hospitalizováni za účelem zavedení trvalé kardiostimulace. Na základě identifikace nejčastějších ošetřovatelských problémů byla vytvořena ošetřovatelská dokumentace, která je komplexní a je určena pro všeobecné sestry a další nelékařské pracovníky.
The implantation of a permanent pacemaker is realized during short-term hospitalization. The goal of this manuscript is to identify the most frequent nursing interventions/needs of patients indicated for permanent pacemaker implantation realized during short-term hospitalization and, subsequently, to develop a complex nursing care map. The data of 100 patients who have been hospitalized for permanent pacemaker implantation have been summarized in a retrospective analysis of their medical records. Based on identification of the most frequent nursing problems, comprehensive nursing documentation was developed that is designated for nurses and other staff who are not doctors.
- Keywords
- krátkodobá hospitalizace, mapa péče, ošetřovatelská intervence,
- MeSH
- Hospitalization MeSH
- Cardiac Pacing, Artificial nursing MeSH
- Critical Pathways * standards MeSH
- Middle Aged MeSH
- Humans MeSH
- Nursing Care standards MeSH
- Nursing Records statistics & numerical data MeSH
- Nursing Assessment * standards MeSH
- Practice Patterns, Nurses' * standards MeSH
- Retrospective Studies MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Research Support, Non-U.S. Gov't MeSH
