A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: an in vivo and in silico study
The aim of this study was to investigate the influence of the activation sequence on voltage amplitudes by evaluating regional voltage differences during a left bundle branch block (LBBB) activation sequence vs. a normal synchronous activation sequence and by evaluating pacing-induced voltage differ...
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| Veröffentlicht in: | Europace (London, England) England), 2018-11, Vol.20 (suppl_3), p.iii77-iii86 |
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| creator | Nguyên, Uyên Châu Potse, Mark Vernooy, Kevin Mafi-Rad, Masih Heijman, Jordi Caputo, Maria Luce Conte, Giulio Regoli, François Krause, Rolf Moccetti, Tiziano Auricchio, Angelo Prinzen, Frits W Maffessanti, Francesco |
| description | The aim of this study was to investigate the influence of the activation sequence on voltage amplitudes by evaluating regional voltage differences during a left bundle branch block (LBBB) activation sequence vs. a normal synchronous activation sequence and by evaluating pacing-induced voltage differences.
Twenty-one patients and three computer models without scar were studied. Regional voltage amplitudes were evaluated in nine LBBB patients who underwent endocardial electro-anatomic mapping (EAM). Pacing-induced voltage differences were evaluated in 12 patients who underwent epicardial EAM during intrinsic rhythm and right ventricular (RV) pacing. Three computer models customized for LBBB patients were created. Changes in voltage amplitudes after an LBBB (intrinsic), a normal synchronous, an RV pacing, and a left ventricular pacing activation sequence were assessed in the computer models. Unipolar voltage amplitudes in patients were approximately 4.5 mV (4.4-4.7 mV, ∼33%) lower in the septum when compared with other segments. A normal synchronous activation sequence in the computer models normalized voltage amplitudes in the septum. Pacing-induced differences were larger in electrograms with higher voltage amplitudes during intrinsic rhythm and furthermore larger and more variable at the epicardium [mean absolute difference: 3.6-6.2 mV, 40-53% of intrinsic value; interquartile range (IQR) differences: 53-63% of intrinsic value] compared to the endocardium (mean absolute difference: 3.3-3.8 mV, 28-30% of intrinsic value; IQR differences: 37-40% of intrinsic value).
In patients and computer models without scar, lower septal unipolar voltage amplitudes are exclusively associated with an LBBB activation sequence. Pacing substantially affects voltage amplitudes, particularly at the epicardium. |
| doi_str_mv | 10.1093/europace/euy233 |
| format | Article |
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Twenty-one patients and three computer models without scar were studied. Regional voltage amplitudes were evaluated in nine LBBB patients who underwent endocardial electro-anatomic mapping (EAM). Pacing-induced voltage differences were evaluated in 12 patients who underwent epicardial EAM during intrinsic rhythm and right ventricular (RV) pacing. Three computer models customized for LBBB patients were created. Changes in voltage amplitudes after an LBBB (intrinsic), a normal synchronous, an RV pacing, and a left ventricular pacing activation sequence were assessed in the computer models. Unipolar voltage amplitudes in patients were approximately 4.5 mV (4.4-4.7 mV, ∼33%) lower in the septum when compared with other segments. A normal synchronous activation sequence in the computer models normalized voltage amplitudes in the septum. Pacing-induced differences were larger in electrograms with higher voltage amplitudes during intrinsic rhythm and furthermore larger and more variable at the epicardium [mean absolute difference: 3.6-6.2 mV, 40-53% of intrinsic value; interquartile range (IQR) differences: 53-63% of intrinsic value] compared to the endocardium (mean absolute difference: 3.3-3.8 mV, 28-30% of intrinsic value; IQR differences: 37-40% of intrinsic value).
In patients and computer models without scar, lower septal unipolar voltage amplitudes are exclusively associated with an LBBB activation sequence. Pacing substantially affects voltage amplitudes, particularly at the epicardium.</description><identifier>ISSN: 1099-5129</identifier><identifier>EISSN: 1532-2092</identifier><identifier>DOI: 10.1093/europace/euy233</identifier><identifier>PMID: 30476054</identifier><language>eng</language><publisher>England: Oxford University Press (OUP)</publisher><subject>Action Potentials ; Adult ; Aged ; Aged, 80 and over ; Bundle of His - diagnostic imaging ; Bundle of His - physiopathology ; Bundle-Branch Block - diagnosis ; Bundle-Branch Block - physiopathology ; Bundle-Branch Block - therapy ; Cardiac Pacing, Artificial - methods ; Cardiology and cardiovascular system ; Computer Simulation ; Electrocardiography ; Electrophysiologic Techniques, Cardiac ; Female ; Heart Rate ; Human health and pathology ; Humans ; Life Sciences ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Models, Cardiovascular ; Time Factors ; Treatment Outcome ; Ventricular Function, Left ; Ventricular Function, Right</subject><ispartof>Europace (London, England), 2018-11, Vol.20 (suppl_3), p.iii77-iii86</ispartof><rights>Distributed under a Creative Commons Attribution 4.0 International License</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c331t-98ca72d050cbaf55fc6bd355484adba74f6d1dabb6ce569208f875a618d643763</citedby><cites>FETCH-LOGICAL-c331t-98ca72d050cbaf55fc6bd355484adba74f6d1dabb6ce569208f875a618d643763</cites><orcidid>0000-0001-5408-5271 ; 0000-0002-8818-5964 ; 0000-0003-2116-6993 ; 0000-0003-4166-2687 ; 0000-0002-1418-108X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30476054$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://inria.hal.science/hal-01933819$$DView record in HAL$$Hfree_for_read</backlink></links><search><creatorcontrib>Nguyên, Uyên Châu</creatorcontrib><creatorcontrib>Potse, Mark</creatorcontrib><creatorcontrib>Vernooy, Kevin</creatorcontrib><creatorcontrib>Mafi-Rad, Masih</creatorcontrib><creatorcontrib>Heijman, Jordi</creatorcontrib><creatorcontrib>Caputo, Maria Luce</creatorcontrib><creatorcontrib>Conte, Giulio</creatorcontrib><creatorcontrib>Regoli, François</creatorcontrib><creatorcontrib>Krause, Rolf</creatorcontrib><creatorcontrib>Moccetti, Tiziano</creatorcontrib><creatorcontrib>Auricchio, Angelo</creatorcontrib><creatorcontrib>Prinzen, Frits W</creatorcontrib><creatorcontrib>Maffessanti, Francesco</creatorcontrib><title>A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: an in vivo and in silico study</title><title>Europace (London, England)</title><addtitle>Europace</addtitle><description>The aim of this study was to investigate the influence of the activation sequence on voltage amplitudes by evaluating regional voltage differences during a left bundle branch block (LBBB) activation sequence vs. a normal synchronous activation sequence and by evaluating pacing-induced voltage differences.
Twenty-one patients and three computer models without scar were studied. Regional voltage amplitudes were evaluated in nine LBBB patients who underwent endocardial electro-anatomic mapping (EAM). Pacing-induced voltage differences were evaluated in 12 patients who underwent epicardial EAM during intrinsic rhythm and right ventricular (RV) pacing. Three computer models customized for LBBB patients were created. Changes in voltage amplitudes after an LBBB (intrinsic), a normal synchronous, an RV pacing, and a left ventricular pacing activation sequence were assessed in the computer models. Unipolar voltage amplitudes in patients were approximately 4.5 mV (4.4-4.7 mV, ∼33%) lower in the septum when compared with other segments. A normal synchronous activation sequence in the computer models normalized voltage amplitudes in the septum. Pacing-induced differences were larger in electrograms with higher voltage amplitudes during intrinsic rhythm and furthermore larger and more variable at the epicardium [mean absolute difference: 3.6-6.2 mV, 40-53% of intrinsic value; interquartile range (IQR) differences: 53-63% of intrinsic value] compared to the endocardium (mean absolute difference: 3.3-3.8 mV, 28-30% of intrinsic value; IQR differences: 37-40% of intrinsic value).
In patients and computer models without scar, lower septal unipolar voltage amplitudes are exclusively associated with an LBBB activation sequence. Pacing substantially affects voltage amplitudes, particularly at the epicardium.</description><subject>Action Potentials</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Bundle of His - diagnostic imaging</subject><subject>Bundle of His - physiopathology</subject><subject>Bundle-Branch Block - diagnosis</subject><subject>Bundle-Branch Block - physiopathology</subject><subject>Bundle-Branch Block - therapy</subject><subject>Cardiac Pacing, Artificial - methods</subject><subject>Cardiology and cardiovascular system</subject><subject>Computer Simulation</subject><subject>Electrocardiography</subject><subject>Electrophysiologic Techniques, Cardiac</subject><subject>Female</subject><subject>Heart Rate</subject><subject>Human health and pathology</subject><subject>Humans</subject><subject>Life Sciences</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Models, Cardiovascular</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Ventricular Function, Left</subject><subject>Ventricular Function, Right</subject><issn>1099-5129</issn><issn>1532-2092</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNo9kUtvFDEQhC0EIg84c0M-wmGIH2PPmNsqggRpJS5wttqPSQxee7FnRtorvxyHSXLqUuurarUKoXeUfKJE8Su_lHwE65s4Mc5foHMqOOsYUexl00SpTlCmztBFrb8IIQNT4jU646QfJBH9Ofq7w9FPMzZLctFjUyDZe2xitr8x2DmsMIeccPV_Fp-sx5AcXn2aS7BLhILb8ZDucEhT3IA1xxnuGng4xjAvztfPzdQAvIY1__c3XUMMNuPagNMb9GqCWP3bx3mJfn798uP6ttt_v_l2vdt3lnM6d2q0MDBHBLEGJiEmK43jQvRjD87A0E_SUQfGSOuFVIyM0zgIkHR0sueD5Jfo45Z7D1EfSzhAOekMQd_u9vphR6jifKRqpY39sLHHktvnddaHUK2PEZLPS9WM8lH2kinS0KsNtSXXWvz0nE2JfihJP5Wkt5Ka4_1j-GIO3j3zT63wf-X6kh8</recordid><startdate>20181101</startdate><enddate>20181101</enddate><creator>Nguyên, Uyên Châu</creator><creator>Potse, Mark</creator><creator>Vernooy, Kevin</creator><creator>Mafi-Rad, Masih</creator><creator>Heijman, Jordi</creator><creator>Caputo, Maria Luce</creator><creator>Conte, Giulio</creator><creator>Regoli, François</creator><creator>Krause, Rolf</creator><creator>Moccetti, Tiziano</creator><creator>Auricchio, Angelo</creator><creator>Prinzen, Frits W</creator><creator>Maffessanti, Francesco</creator><general>Oxford University Press (OUP)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>1XC</scope><scope>VOOES</scope><orcidid>https://orcid.org/0000-0001-5408-5271</orcidid><orcidid>https://orcid.org/0000-0002-8818-5964</orcidid><orcidid>https://orcid.org/0000-0003-2116-6993</orcidid><orcidid>https://orcid.org/0000-0003-4166-2687</orcidid><orcidid>https://orcid.org/0000-0002-1418-108X</orcidid></search><sort><creationdate>20181101</creationdate><title>A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: an in vivo and in silico study</title><author>Nguyên, Uyên Châu ; Potse, Mark ; Vernooy, Kevin ; Mafi-Rad, Masih ; Heijman, Jordi ; Caputo, Maria Luce ; Conte, Giulio ; Regoli, François ; Krause, Rolf ; Moccetti, Tiziano ; Auricchio, Angelo ; Prinzen, Frits W ; Maffessanti, Francesco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c331t-98ca72d050cbaf55fc6bd355484adba74f6d1dabb6ce569208f875a618d643763</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Action Potentials</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Bundle of His - diagnostic imaging</topic><topic>Bundle of His - physiopathology</topic><topic>Bundle-Branch Block - diagnosis</topic><topic>Bundle-Branch Block - physiopathology</topic><topic>Bundle-Branch Block - therapy</topic><topic>Cardiac Pacing, Artificial - methods</topic><topic>Cardiology and cardiovascular system</topic><topic>Computer Simulation</topic><topic>Electrocardiography</topic><topic>Electrophysiologic Techniques, Cardiac</topic><topic>Female</topic><topic>Heart Rate</topic><topic>Human health and pathology</topic><topic>Humans</topic><topic>Life Sciences</topic><topic>Magnetic Resonance Imaging</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Models, Cardiovascular</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Ventricular Function, Left</topic><topic>Ventricular Function, Right</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Nguyên, Uyên Châu</creatorcontrib><creatorcontrib>Potse, Mark</creatorcontrib><creatorcontrib>Vernooy, Kevin</creatorcontrib><creatorcontrib>Mafi-Rad, Masih</creatorcontrib><creatorcontrib>Heijman, Jordi</creatorcontrib><creatorcontrib>Caputo, Maria Luce</creatorcontrib><creatorcontrib>Conte, Giulio</creatorcontrib><creatorcontrib>Regoli, François</creatorcontrib><creatorcontrib>Krause, Rolf</creatorcontrib><creatorcontrib>Moccetti, Tiziano</creatorcontrib><creatorcontrib>Auricchio, Angelo</creatorcontrib><creatorcontrib>Prinzen, Frits W</creatorcontrib><creatorcontrib>Maffessanti, Francesco</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Hyper Article en Ligne (HAL)</collection><collection>Hyper Article en Ligne (HAL) (Open Access)</collection><jtitle>Europace (London, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Nguyên, Uyên Châu</au><au>Potse, Mark</au><au>Vernooy, Kevin</au><au>Mafi-Rad, Masih</au><au>Heijman, Jordi</au><au>Caputo, Maria Luce</au><au>Conte, Giulio</au><au>Regoli, François</au><au>Krause, Rolf</au><au>Moccetti, Tiziano</au><au>Auricchio, Angelo</au><au>Prinzen, Frits W</au><au>Maffessanti, Francesco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: an in vivo and in silico study</atitle><jtitle>Europace (London, England)</jtitle><addtitle>Europace</addtitle><date>2018-11-01</date><risdate>2018</risdate><volume>20</volume><issue>suppl_3</issue><spage>iii77</spage><epage>iii86</epage><pages>iii77-iii86</pages><issn>1099-5129</issn><eissn>1532-2092</eissn><abstract>The aim of this study was to investigate the influence of the activation sequence on voltage amplitudes by evaluating regional voltage differences during a left bundle branch block (LBBB) activation sequence vs. a normal synchronous activation sequence and by evaluating pacing-induced voltage differences.
Twenty-one patients and three computer models without scar were studied. Regional voltage amplitudes were evaluated in nine LBBB patients who underwent endocardial electro-anatomic mapping (EAM). Pacing-induced voltage differences were evaluated in 12 patients who underwent epicardial EAM during intrinsic rhythm and right ventricular (RV) pacing. Three computer models customized for LBBB patients were created. Changes in voltage amplitudes after an LBBB (intrinsic), a normal synchronous, an RV pacing, and a left ventricular pacing activation sequence were assessed in the computer models. Unipolar voltage amplitudes in patients were approximately 4.5 mV (4.4-4.7 mV, ∼33%) lower in the septum when compared with other segments. A normal synchronous activation sequence in the computer models normalized voltage amplitudes in the septum. Pacing-induced differences were larger in electrograms with higher voltage amplitudes during intrinsic rhythm and furthermore larger and more variable at the epicardium [mean absolute difference: 3.6-6.2 mV, 40-53% of intrinsic value; interquartile range (IQR) differences: 53-63% of intrinsic value] compared to the endocardium (mean absolute difference: 3.3-3.8 mV, 28-30% of intrinsic value; IQR differences: 37-40% of intrinsic value).
In patients and computer models without scar, lower septal unipolar voltage amplitudes are exclusively associated with an LBBB activation sequence. Pacing substantially affects voltage amplitudes, particularly at the epicardium.</abstract><cop>England</cop><pub>Oxford University Press (OUP)</pub><pmid>30476054</pmid><doi>10.1093/europace/euy233</doi><orcidid>https://orcid.org/0000-0001-5408-5271</orcidid><orcidid>https://orcid.org/0000-0002-8818-5964</orcidid><orcidid>https://orcid.org/0000-0003-2116-6993</orcidid><orcidid>https://orcid.org/0000-0003-4166-2687</orcidid><orcidid>https://orcid.org/0000-0002-1418-108X</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Oxford Journals Open Access Collection; EZB-FREE-00999 freely available EZB journals; PubMed Central; Alma/SFX Local Collection |
| subjects | Action Potentials Adult Aged Aged, 80 and over Bundle of His - diagnostic imaging Bundle of His - physiopathology Bundle-Branch Block - diagnosis Bundle-Branch Block - physiopathology Bundle-Branch Block - therapy Cardiac Pacing, Artificial - methods Cardiology and cardiovascular system Computer Simulation Electrocardiography Electrophysiologic Techniques, Cardiac Female Heart Rate Human health and pathology Humans Life Sciences Magnetic Resonance Imaging Male Middle Aged Models, Cardiovascular Time Factors Treatment Outcome Ventricular Function, Left Ventricular Function, Right |
| title | A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: an in vivo and in silico study |
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