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Case Reports
. 2021 Sep 29;7(12):849-853.
doi: 10.1016/j.hrcr.2021.09.009. eCollection 2021 Dec.

Noninvasive electrocardiographic imaging of dynamic atrioventricular delay programming in a patient with left bundle branch block

Peter H Waddingham  1   2 , Jan Mangual  3 , Michele Orini  4 , Nima Badie  3 , Luke McSpadden  3 , Pier D Lambiase  1   4 , Anthony W C Chow  1   2
Affiliations
Case Reports

Noninvasive electrocardiographic imaging of dynamic atrioventricular delay programming in a patient with left bundle branch block

Peter H Waddingham et al. HeartRhythm Case Rep. .
No abstract available

Keywords: Atrioventricular delay; CRT optimization; Electrocardiography imaging; MultiPoint Pacing; SyncAV.

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Figures

Figure 1
Figure 1
Chest radiograph displaying device and lead positions. This posteroanterior projection shows the final positions of the device and leads. Left ventricular (LV) lead was placed at the basal-mid posterolateral branch of the coronary sinus, right ventricular (RV) lead at the RV apex, and right atrial (RA) lead in the RA appendage.
Figure 2
Figure 2
Twelve-lead surface electrocardiogram (ECG). The 12-lead surface ECG ensemble signals averaged over 3 successive beats are displayed for intrinsic conduction, biventricular (BiV) + SyncAV, Multi-Point Pacing (MPP) + SyncAV, left ventricle–only single-site pacing (LVSS) + SyncAV, and LV-only MPP (LVMPP) + SyncAV (left to right). QRS durations (QRSd) are displayed, with QRS start and end times shown as dashed vertical lines.
Figure 3
Figure 3
Electrocardiographic imaging activation maps. Epicardial ventricular surfaces of both ventricles are displayed in 3 views: from left to right, right anterior oblique (RAO), left anterior oblique (LAO), and left lateral (LL). The left anterior descending (LAD) artery, right ventricle (RV) lead tip, and left ventricle (LV) lead are depicted as silver surfaces. Color maps are projected onto the surface for activation time (AT, ms), ranging from early (red/orange) to late (blue/purple). Intrinsic conduction activation maps show the earliest-activating regions in the anterior RV (inclusive of septal activation) and RV free wall in keeping with intact right bundle conduction. The latest-activating LV segment is basal lateral, and a U-shaped line of activation discontinuity is present from the basal anterior-anterolateral LV spreading apically to the basal posterior LV. The impact of each pacing modality on activation pattern is displayed: A: intrinsic conduction; B: biventricular (BiV) + SyncAV; C: MultiPoint Pacing (MPP) + SyncAV; D: LV-only single-site pacing (LVSS) + SyncAV; E: LV-only MPP (LVMPP) + SyncAV.
See this image and copyright information in PMC

References

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