Noninvasive activation mapping during the cardiac conductive system pacing

M. S. Medved, S. Zubarev, T. Chumarnaya, A. E. Bazhutina, O. Solovyova, D. S. Lebedev
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Abstract

Aim. To identify the features of activation of the right and left ventricles during cardiac conductive system pacing.Methods. There are 2 groups of the study. The cardiac conductive pacing carried in patients of first group. The cardiac conductive pacing not carried in patients of second group. Before and after implantation of the pacemaker, all patients underwent ECG, noninvasive activation mapping using the Amycard software and hardware complex, the width of the QRS, the activation time of the left (LVAT) and right (RVAT) ventricles were determined initially and against the background of pacing. The parameter values are presented in the format: median and interquartile range (Me [25; 75]).Results. The study protocol was performed in 30 patients: first group - 20 patients, second group - 10. The age of the patients was 73 [57; 81] and 71 [63; 75] years, respectively. The value of native QRS complexes in first group was 106 [100; 132] msec, in second group - 144 [109; 155] msec; LVAT 70 [60; 93] msec and 88 [75; 115] msec, respectively; RVAT 62 [50; 74] msec and 85 [67; 117] msec, respectively. There were no statistically significant differences between the groups (p > 0.05) in age, values of native QRS, LVAT, RVAT. The implantable electrode model is identical in both groups. The value of the QRS complex during pacing in first group was 117 [109; 125] msec and 160 [145; 173] msec in second group; LVATp 76 [65; 89] msec and 129 [119; 148] msec, respectively; RVAT 67 [60; 80] msec and 108 [90; 128] msec, respectively. The study revealed statistically significant differences between the two groups of all evaluated parameters against the background of pacing: QRS (p = 0.01), LVAT (p = < 0.01), RVAT (p < 0.01). It should be noted that the initial values and values against the background of pacing of the QRS, LVAT, RVAT complex in patients of group No. 1 did not differ (p > 0.05); in patients of the second group, the values of the QRS, LVAT, RVAT complex initially and against the background of stimulation had significant differences (p = 0.11, p < 0.01 and p = 0.038 respectively).Conclusion. Cardiac conductive system paving is a promising method of cardiac pacing, which allows to achieve activation of the myocardium of the left and right ventricles, which does not differ significantly from activation with a sinus rhythm.
心脏传导系统起搏时的无创激活图谱
目的确定心脏传导系统起搏时左右心室激活的特征。研究分为两组。第一组患者进行心脏传导起搏。第二组患者未进行心脏传导起搏。在植入起搏器前后,所有患者都接受了心电图检查,并使用 Amycard 软件和硬件复合物进行了无创活化图绘制,初步确定了 QRS 宽度、左心室(LVAT)和右心室(RVAT)的活化时间以及起搏背景。参数值以中位数和四分位数间距(Me [25; 75])的格式显示。研究方案在 30 名患者中实施:第一组--20 名患者,第二组--10 名患者。患者年龄分别为 73 [57; 81] 岁和 71 [63; 75] 岁。第一组的原始 QRS 波群值为 106 [100; 132] 毫秒,第二组为 144 [109; 155] 毫秒;LVAT 分别为 70 [60; 93] 毫秒和 88 [75; 115] 毫秒;RVAT 分别为 62 [50; 74] 毫秒和 85 [67; 117] 毫秒。在年龄、原始 QRS 值、LVAT 和 RVAT 方面,组间差异无统计学意义(P > 0.05)。两组的植入电极型号相同。第一组起搏时的 QRS 波群值为 117 [109; 125] 毫秒,第二组为 160 [145; 173] 毫秒;LVATp 分别为 76 [65; 89] 毫秒和 129 [119; 148] 毫秒;RVAT 分别为 67 [60; 80] 毫秒和 108 [90; 128] 毫秒。研究显示,在起搏背景下,两组间所有评估参数的差异均有统计学意义:QRS (p = 0.01)、LVAT (p = < 0.01)、RVAT (p < 0.01)。值得注意的是,第一组患者 QRS、LVAT、RVAT 复极的初始值和起搏背景值没有差异(p > 0.05);第二组患者 QRS、LVAT、RVAT 复极的初始值和刺激背景值有显著差异(分别为 p = 0.11、p < 0.01 和 p = 0.038)。心脏传导系统铺桥是一种很有前景的心脏起搏方法,它可以实现左心室和右心室心肌的激活,与窦性心律激活没有明显差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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