Noninvasive activation mapping during the cardiac conductive system pacing

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.