Arquivos Brasileiros de Cardiologia (Mar 2007)

Ativação elétrica ventricular na ressincronização cardíaca caracterizada pelo mapeamento eletrocardiográfico de superfície Ventricular electrical activation in cardiac resynchronization as characterized by body surface potential mapping

  • Carlos Alberto Pastore,
  • Nancy Tobias,
  • Nelson Samesima,
  • Martino Martinelli Filho,
  • Anisio Pedrosa,
  • Silvana Nishioka,
  • Roberto A. Douglas,
  • Luiz Felipe Pinho Moreira,
  • José Franchini Ramires

DOI
https://doi.org/10.1590/S0066-782X2007000300001
Journal volume & issue
Vol. 88, no. 3
pp. 251 – 257

Abstract

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OBJETIVOS: Avaliar a ativação elétrica cardíaca usando Mapeamento Eletrocardiográfico de Superfície (MES), em pacientes com ICC e bloqueio de ramo esquerdo [BRE] submetidos a terapia de ressincronização cardíaca (CRT) com implante de marca-passo átrio-biventricular (MP-BIV). MÉTODOS: Foram analisados os tempos médios de ativação elétrica cardíaca no ventrículo direito (tempo médio de ativação do VD [mVD]), área ântero-septal (mAS), e ventrículo esquerdo (mVE), de 28 pacientes (idade média 61,2±9,5 anos, ICC classe III-IV NYHA, fração de ejeção OBJECTIVES: To assess cardiac electrical activation by using body surface potential mapping (BSPM), in patients with congestive heart failure (CHF) and left bundle branch block (LBBB) undergoing cardiac resynchronization therapy (CRT) with biventricular pacemaker (BIV-PM) implantation. METHODS: Mean cardiac electrical activation times were analyzed in the right ventricle (RV) (mean RV activation time = mRV), anteroseptal area (mAS), and left ventricle (mLV) of 28 patients (mean age 61.2 ± 9.5 years; NYHA class III-IV CHF; ejection fraction <40%; LBBB of mean QRS 181.2±19.4ms, SÂQRS -8.5º±68.6º), as shown in their BSPM isochronous maps, before and after implantation of atriobiventricular pacemaker, comparing those with values obtained from a control group of normal individuals [CG], in three situations: (1) native LBBB; (2) RV pacing; and (3) atriobiventricular pacing. RESULTS: Situation (1): mRV and mAS values were similar (41.0±11.8ms x 43.6±13.4ms), with delayed mLV (81.0±12.5ms, p<0.01) and asynchronous with RV and AS areas; situation (2): mRV was greater than in CG (86.8±22.9ms, p<0.001), with greater difference between mAS and mLV (63.4±20.7ms vs. 102.7±20.3ms; p<0,001); situation (3): mLV and mRV were similar (72.0±32.0ms vs. 71.6±32.3ms), mRV was greater than in CG and native LBBB (71.6±32.3ms vs. 35.1±10.9ms and 41.0±11.8ms; p<0.001), and mAS was close to CG and native LBBB values (51.3±32.8ms vs. 50.1±11.4ms and 43.6±13.4ms). CONCLUSION: The body surface potential mapping showed that RV and LV activation times which are similar, and are close to those of the AS area, suggest patterns of synchronized ventricular activation in patients with CHF and LBBB during atriobiventricular pacing.

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