A different cardiac resynchronization therapy technique might be needed in some patients with nonspecific intraventricular conduction disturbance pattern  

作　　者：Gábor Katona Zsuzsanna Szelényi Gábor Szénási Bálint Kozman Zsolt Rekvényi Luca Kópházi Zsolt Dobos Szilvia Vereckei András Vereckei 

机构地区：[1]Department of Medicine and Hematology,Semmelweis University,Budapest,Hungary [2]Heart and Vascular Center,Semmelweis University,Budapest,Hungary [3]Institute of Translational Medicine,Semmelweis University,Budapest,Hungary [4]Ardinsys Ltd.,Budapest,Hungary [5]Budapest University of Technology and Economics,Faculty of Architecture,Budapest,Hungary

出　　处：《Journal of Geriatric Cardiology》2021年第12期975-985,共11页老年心脏病学杂志（英文版）

基　　金：supported by the Hungarian Ministry of Human Resources(UNKP-16-2)。

摘　　要：BACKGROUND Current cardiac resynchronization therapy(CRT),devised to eliminate dyssynchrony in left bundle branch block(LBBB),works by pacing the latest activated left ventricular site(LALVS).We hypothesized that patients with nonspecific intraventricular conduction disturbance(NICD)pattern respond less favorably to CRT,because their LALVS is far away from that in LBBB.METHODS By measuring the amplitude and polarity of secondary ST-segment alterations in two optional frontal and hori-zontal surface electrocardiogram(ECG)leads and using a software,we determined the resultant 3D spatial secondary ST vector,which is directed 180o away from the LALVS,in 110 patients with LBBB pattern and 77 patients with NICD pattern and heart failure.To validate the ECG method,we also estimated the LALVS by echocardiography using 3D parametric imaging and 2D speckle tracking in 22 LBBB patients and 20 NICD patients.Patients with NICD pattern were subdivided according to their non-overlapping frontal plane resultant secondary ST vector ranges to the NICD-1 subgroup(n=44)and the NICD-2 subgroup(n=33).RESULTS Based on the software determined coordinates of the resultant 3D spatial secondary ST vector directed 180o away from the LALVS,the LALVSs were located leftward,posterosuperior in the LBBB group,slightly left,superior in the NICD-1 sub-group,and slightly left,posteroinferior in the NICD-2 subgroup.The LALVS determined by ECG and echocardiography matched in all patients,except two.CONCLUSIONS In the NICD-2 subgroup,a remote LALVS was found from that in LBBB pattern,which might explain the high non-response rate of the NICD pattern to the current CRT technique.

关 键 词：PATIENTS PATTERN VENTRICULAR 

分 类 号：R541.7[医药卫生—心血管疾病]