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A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: an in vivo and in silico study

Abstract : Aims 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 ven-tricular (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
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Submitted on : Saturday, November 24, 2018 - 2:21:56 PM
Last modification on : Thursday, January 20, 2022 - 4:20:52 PM
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Uyên Châu Nguyên, Mark Potse, Kevin Vernooy, Masih Mafi-Rad, Jordi Heijman, et al.. A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: an in vivo and in silico study. EP-Europace, Oxford University Press (OUP): Policy B, 2018, 20 (suppl-3), pp.iii77 - iii86. ⟨10.1093/europace/euy233⟩. ⟨hal-01933819⟩



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