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Journal of Cardiovascular Translational Research

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Open Access 01-04-2012

Electrical and Mechanical Ventricular Activation During Left Bundle Branch Block and Resynchronization

Authors: Marc Strik, François Regoli, Angelo Auricchio, Frits Prinzen

Published in: Journal of Cardiovascular Translational Research | Issue 2/2012

Abstract

Cardiac resynchronization therapy (CRT) aims to treat selected heart failure patients suffering from conduction abnormalities with left bundle branch block (LBBB) as the culprit disease. LBBB remained largely underinvestigated until it became apparent that the amount of response to CRT was heterogeneous and that the therapy and underlying pathology were thus incompletely understood. In this review, current knowledge concerning activation in LBBB and during biventricular pacing will be explored and applied to current CRT practice, highlighting novel ways to better measure and treat the electrical substrate.

Strik, M., Ploux, S., Vernooy, K., & Prinzen, F. W. (2011). Cardiac resynchronization therapy: refocus on the electrical substrate. Circulation Journal, 75, 1297–1304.PubMedCrossRef

Vernooy, K., Cornelussen, R. N., Verbeek, X. A., Vanagt, W. Y., van Hunnik, A., Kuiper, M., et al. (2007). Cardiac resynchronization therapy cures dyssynchronopathy in canine left bundle-branch block hearts. European Heart Journal, 28, 2148–2155. doi:10.1093/eurheartj/ehm207.PubMedCrossRef

Bilchick, K. C., Kamath, S., DiMarco, J. P., & Stukenborg, G. J. (2010). Bundle-branch block morphology and other predictors of outcome after cardiac resynchronization therapy in medicare patients. Circulation, 122, 2022–2030. doi:10.1161/CIRCULATIONAHA.110.956011.PubMedCrossRef

Eppinger, H., & Rothberger, J. (1910). Ueber die folgen der durchschneidung der tawaraschen schenkel des reizleitungssystems. Zeitschrift für Klinische Medizin, 70, 1–20.

Demoulin, J. C., & Kulbertus, H. E. (1972). Histopathological examination of concept of left hemiblock. British Heart Journal, 34, 807–814.PubMedCrossRef

Massing, G. K., & James, T. N. (1976). Anatomical configuration of the his bundle and bundle branches in the human heart. Circulation, 53, 609–621.PubMed

Durrer, D., van Dam, R. T., Freud, G. E., Janse, M. J., Meijler, F. L., & Arzbaecher, R. C. (1970). Total excitation of the isolated human heart. Circulation, 41, 899–912.PubMed

Strik, M., van Middendorp, L. B., & Vernooy, K. (2011). Animal models of dyssynchrony. Journal of Cardiovascular Translational Research. doi:10.1007/s12265-011-9336-5.

Vassallo, J. A., Cassidy, D. M., Marchlinski, F. E., Buxton, A. E., Waxman, H. L., Doherty, J. U., et al. (1984). Endocardial activation of left bundle branch block. Circulation, 69, 914–923.PubMedCrossRef

10.

Jia, P., Ramanathan, C., Ghanem, R. N., Ryu, K., Varma, N., & Rudy, Y. (2006). Electrocardiographic imaging of cardiac resynchronization therapy in heart failure: observation of variable electrophysiologic responses. Heart Rhythm, 3(Jia P, Ramanathan C, Ghanem RN, Ryu K, Varma N, Rudy Y), 296–310. doi:10.1016/j.hrthm.2005.11.025.PubMedCrossRef

11.

Rodriguez, L. M., Timmermans, C., Nabar, A., Beatty, G., & Wellens, H. J. (2003). Variable patterns of septal activation in patients with left bundle branch block and heart failure. Journal of Cardiovascular Electrophysiology, 14, 135–141.PubMedCrossRef

12.

Auricchio, A., Fantoni, C., Regoli, F., Carbucicchio, C., Goette, A., Geller, C., et al. (2004). Characterization of left ventricular activation in patients with heart failure and left bundle-branch block. Circulation, 109, 1133–1139. doi:10.1161/01.CIR.0000118502.91105.F6.PubMedCrossRef

13.

Narula, O. S. (1977). Longitudinal dissociation in the his bundle. Bundle branch block due to asynchronous conduction within the His bundle in man. Circulation, 56, 996–1006.PubMed

14.

Bacharova, L., Mateasik, A., Krause, R., Prinzen, F. W., Auricchio, A., & Potse, M. (2011). The effect of reduced intercellular coupling on electrocardiographic signs of left ventricular hypertrophy. Journal of Electrocardiology, 44, 571–576. doi:10.1016/j.jelectrocard.2011.06.004.PubMedCrossRef

15.

Surawicz, B., Childers, R., Deal, B. J., Gettes, L. S., Bailey, J. J., Gorgels, A., et al. (2009). Aha/accf/hrs recommendations for the standardization and interpretation of the electrocardiogram: Part III: intraventricular conduction disturbances. Journal of the American College of Cardiology, 53, 976–981. doi:10.1016/j.jacc.2008.12.013.PubMedCrossRef

16.

Strauss, D. G., Selvester, R. H., Lima, J. A., Arheden, H., Miller, J. M., Gerstenblith, G., et al. (2008). Ecg quantification of myocardial scar in cardiomyopathy patients with or without conduction defects: correlation with cardiac magnetic resonance and arrhythmogenesis. Circulation. Arrhythmia and Electrophysiology, 1, 327–336. doi:10.1161/CIRCEP.108.798660.PubMedCrossRef

17.

Fantoni, C., Kawabata, M., Massaro, R., Regoli, F., Raffa, S., Arora, V., et al. (2005). Right and left ventricular activation sequence in patients with heart failure and right bundle branch block: a detailed analysis using three-dimensional non-fluoroscopic electroanatomic mapping system. Journal of Cardiovascular Electrophysiology, 16, 112–119. doi:10.1046/j.1540-8167.2005.40777.x. discussion 120-111.PubMedCrossRef

18.

Tang, A. S., Wells, G. A., Talajic, M., Arnold, M. O., Sheldon, R., Connolly, S., et al. (2010). Cardiac-resynchronization therapy for mild-to-moderate heart failure. The New England Journal of Medicine. doi:10.1056/NEJMoa1009540.

19.

Gervais, R., Leclercq, C., Shankar, A., Jacobs, S., Eiskjaer, H., Johannessen, A., et al. (2009). Surface electrocardiogram to predict outcome in candidates for cardiac resynchronization therapy: a sub-analysis of the care-hf trial. European Journal of Heart Failure, 11, 699–705. doi:10.1093/eurjhf/hfp074.PubMedCrossRef

20.

Zareba, W., Klein, H., Cygankiewicz, I., Hall, W. J., McNitt, S., Brown, M., et al. (2011). Effectiveness of cardiac resynchronization therapy by qrs morphology in the multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (madit-crt). Circulation, 123, 1061–1072. doi:10.1161/CIRCULATIONAHA.110.960898.PubMedCrossRef

21.

Sipahi, I., Carrigan, T. P., Rowland, D. Y., Stambler, B. S., & Fang, J. C. (2011). Impact of QRS duration on clinical event reduction with cardiac resynchronization therapy: meta-analysis of randomized controlled trials. Archives of Internal Medicine. doi:10.1001/archinternmed.2011.247.

22.

Hsing, J. M., Selzman, K. A., Leclercq, C., Pires, L. A., McLaughlin, M. G., McRae, S. E., et al. (2011). Paced left ventricular qrs width and ecg parameters predict outcomes after cardiac resynchronization therapy: prospect-ECG sub-study. Circulation. Arrhythmia and Electrophysiology. doi:10.1161/CIRCEP.111.962605.

23.

Grant, R. P., & Dodge, H. T. (1956). Mechanisms of QRS complex prolongation in man; left ventricular conduction disturbances. American Journal of Medicine, 20, 834–852.PubMedCrossRef

24.

Strauss, D. G., & Selvester, R. H. (2009). The QRS complex—a biomarker that “images” the heart: QRS scores to quantify myocardial scar in the presence of normal and abnormal ventricular conduction. Journal of Electrocardiology, 42, 85–96. doi:10.1016/j.jelectrocard.2008.07.011.PubMedCrossRef

25.

Chung, E. S., Leon, A. R., Tavazzi, L., Sun, J. P., Nihoyannopoulos, P., Merlino, J., et al. (2008). Results of the predictors of response to CRT (prospect) trial. Circulation, 117, 2608–2616. doi:10.1161/CIRCULATIONAHA.107.743120.PubMedCrossRef

26.

Sweeney, M. O., van Bommel, R. J., Schalij, M. J., Borleffs, C. J., Hellkamp, A. S., & Bax, J. J. (2010). Analysis of ventricular activation using surface electrocardiography to predict left ventricular reverse volumetric remodeling during cardiac resynchronization therapy. Circulation, 121, 626–634. doi:10.1161/CIRCULATIONAHA.109.894774.PubMedCrossRef

27.

Varma, N. (2009). Left ventricular conduction delays and relation to qrs configuration in patients with left ventricular dysfunction. The American Journal of Cardiology, 103, 1578–1585. doi:10.1016/j.amjcard.2009.01.379.PubMedCrossRef

28.

Singh, J. P., Fan, D., Heist, E. K., Alabiad, C. R., Taub, C., Reddy, V., et al. (2006). Left ventricular lead electrical delay predicts response to cardiac resynchronization therapy. Heart Rhythm, 3, 1285–1292. doi:10.1016/j.hrthm.2006.07.034.PubMedCrossRef

29.

Fung, J. W., Chan, J. Y., Yip, G. W., Chan, H. C., Chan, W. W., Zhang, Q., et al. (2007). Effect of left ventricular endocardial activation pattern on echocardiographic and clinical response to cardiac resynchronization therapy. Heart, 93, 432–437. doi:10.1136/hrt.2007.115295.PubMedCrossRef

30.

Mollema, S. A., Bleeker, G. B., van der Wall, E. E., Schalij, M. J., & Bax, J. J. (2007). Usefulness of qrs duration to predict response to cardiac resynchronization therapy in patients with end-stage heart failure. The American Journal of Cardiology, 100, 1665–1670. doi:10.1016/j.amjcard.2007.06.071.PubMedCrossRef

31.

Marcus, G. M., Rose, E., Viloria, E. M., Schafer, J., De Marco, T., Saxon, L. A., et al. (2005). Septal to posterior wall motion delay fails to predict reverse remodeling or clinical improvement in patients undergoing cardiac resynchronization therapy. Journal of the American College of Cardiology, 46, 2208–2214. doi:10.1016/j.jacc.2005.05.095.PubMedCrossRef

32.

Pitzalis, M. V., Iacoviello, M., Romito, R., Guida, P., De Tommasi, E., Luzzi, G., et al. (2005). Ventricular asynchrony predicts a better outcome in patients with chronic heart failure receiving cardiac resynchronization therapy. Journal of the American College of Cardiology, 45, 65–69. doi:10.1016/j.jacc.2004.09.058.PubMedCrossRef

33.

Seo, Y., Ito, H., Nakatani, S., Takami, M., Naito, S., Shiga, T., et al. (2011). The role of echocardiography in predicting responders to cardiac resynchronization therapy. Circulation Journal, 75, 1156–1163.PubMedCrossRef

34.

Russel, I. K., Zwanenburg, J. J., Germans, T., Marcus, J. T., Allaart, C. P., de Cock, C. C., et al. (2007). Mechanical dyssynchrony or myocardial shortening as mri predictor of response to biventricular pacing? Journal of Magnetic Resonance Imaging, 26, 1452–1460. doi:10.1002/jmri.21133.PubMedCrossRef

35.

Torrent-Guasp, F., Kocica, M. J., Corno, A. F., Komeda, M., Carreras-Costa, F., Flotats, A., et al. (2005). Towards new understanding of the heart structure and function. European Journal of Cardio-Thoracic Surgery, 27, 191–201. doi:10.1016/j.ejcts.2004.11.026.PubMedCrossRef

36.

Voigt, J. U., Schneider, T. M., Korder, S., Szulik, M., Gurel, E., Daniel, W. G., et al. (2009). Apical transverse motion as surrogate parameter to determine regional left ventricular function inhomogeneities: a new, integrative approach to left ventricular asynchrony assessment. European Heart Journal, 30, 959–968. doi:10.1093/eurheartj/ehp062.PubMedCrossRef

37.

Lim, P., Buakhamsri, A., Popovic, Z. B., Greenberg, N. L., Patel, D., Thomas, J. D., et al. (2008). Longitudinal strain delay index by speckle tracking imaging: a new marker of response to cardiac resynchronization therapy. Circulation, 118, 1130–1137. doi:10.1161/CIRCULATIONAHA.107.750190.PubMedCrossRef

38.

Klimusina, J., De Boeck, B. W., Leenders, G. E., Faletra, F. F., Prinzen, F., Averaimo, M., et al. (2011). Redistribution of left ventricular strain by cardiac resynchronization therapy in heart failure patients. European Journal of Heart Failure, 13, 186–194. doi:10.1093/eurjhf/hfq197.PubMedCrossRef

39.

Tanaka, H., Nesser, H. J., Buck, T., Oyenuga, O., Janosi, R. A., Winter, S., et al. (2010). Dyssynchrony by speckle-tracking echocardiography and response to cardiac resynchronization therapy: results of the speckle tracking and resynchronization (star) study. European Heart Journal, 31, 1690–1700. doi:10.1093/eurheartj/ehq213.PubMedCrossRef

40.

De Boeck, B. W., Teske, A. J., Meine, M., Leenders, G. E., Cramer, M. J., Prinzen, F. W., et al. (2009). Septal rebound stretch reflects the functional substrate to cardiac resynchronization therapy and predicts volumetric and neurohormonal response. European Journal of Heart Failure, 11, 863–871. doi:10.1093/eurjhf/hfp107.PubMedCrossRef

41.

Helm, R. H., Leclercq, C., Faris, O. P., Ozturk, C., McVeigh, E., Lardo, A. C., et al. (2005). Cardiac dyssynchrony analysis using circumferential versus longitudinal strain: implications for assessing cardiac resynchronization. Circulation, 111, 2760–2767. doi:10.1161/CIRCULATIONAHA.104.508457.PubMedCrossRef

42.

Bilchick, K. C., Dimaano, V., Wu, K. C., Helm, R. H., Weiss, R. G., Lima, J. A., et al. (2008). Cardiac magnetic resonance assessment of dyssynchrony and myocardial scar predicts function class improvement following cardiac resynchronization therapy. JACC. Cardiovascular Imaging, 1, 561–568. doi:10.1016/j.jcmg.2008.04.013.PubMedCrossRef

43.

Mangiavacchi, M., Gasparini, M., Faletra, F., Klersy, C., Morenghi, E., Galimberti, P., et al. (2006). Clinical predictors of marked improvement in left ventricular performance after cardiac resynchronization therapy in patients with chronic heart failure. American Heart Journal, 151, 477 e471–477 e476. doi:10.1016/j.ahj.2005.08.008.CrossRef

44.

St John Sutton, M. G., Plappert, T., Abraham, W. T., Smith, A. L., DeLurgio, D. B., Leon, A. R., et al. (2003). Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation, 107, 1985–1990. doi:10.1161/01.CIR.0000065226.24159.E9.PubMedCrossRef

45.

Rademakers, L. M., van Kerckhoven, R., van Deursen, C. J., Strik, M., van Hunnik, A., Kuiper, M., et al. (2010). Myocardial infarction does not preclude electrical and hemodynamic benefits of cardiac resynchronization therapy in dyssynchronous canine hearts circulation. Arrhythmia and Electrophysiology, 3, 361–368. doi:10.1161/CIRCEP.109.931865.PubMedCrossRef

46.

Chalil, S., Foley, P. W., Muyhaldeen, S. A., Patel, K. C., Yousef, Z. R., Smith, R. E., et al. (2007). Late gadolinium enhancement-cardiovascular magnetic resonance as a predictor of response to cardiac resynchronization therapy in patients with ischaemic cardiomyopathy. Europace, 9, 1031–1037. doi:10.1093/europace/eum133.PubMedCrossRef

47.

Leyva, F., Foley, P. W., Chalil, S., Ratib, K., Smith, R. E., Prinzen, F., et al. (2011). Cardiac resynchronisation therapy guided by late gadolinium-enhancement cardiovascular magnetic resonance. Journal of Cardiovascular Magnetic Resonance, 13, 29. doi:10.1186/1532-429X-13-29.PubMedCrossRef

48.

Delgado, V., van Bommel, R. J., Bertini, M., Borleffs, C. J., Marsan, N. A., Arnold, C. T., et al. (2011). Relative merits of left ventricular dyssynchrony, left ventricular lead position, and myocardial scar to predict long-term survival of ischemic heart failure patients undergoing cardiac resynchronization therapy. Circulation, 123, 70–78. doi:10.1161/CIRCULATIONAHA.110.945345.PubMedCrossRef

49.

Faletra, F. F., Conca, C., Klersy, C., Klimusina, J., Regoli, F., Mantovani, A., et al. (2009). Comparison of eight echocardiographic methods for determining the prevalence of mechanical dyssynchrony and site of latest mechanical contraction in patients scheduled for cardiac resynchronization therapy. The American Journal of Cardiology, 103, 1746–1752. doi:10.1016/j.amjcard.2009.02.043.PubMedCrossRef

50.

Strik, M., Rademakers, L. M., van Deursen, C. J., van Hunnik, A., Kuiper, M., Klersy, C., et al. (2011). Endocardial left ventricular pacing improves cardiac resynchronization therapy in chronic asynchronous infarction and heart failure models. Circulation. Arrhythmia and Electrophysiology. doi:10.1161/CIRCEP.111.965814.

51.

van Deursen, C., van Geldorp, I. E., Rademakers, L. M., van Hunnik, A., Kuiper, M., Klersy, C., et al. (2009). Left ventricular endocardial pacing improves resynchronization therapy in canine left bundle-branch hearts. Circulation. Arrhythmia and Electrophysiology, 2, 580–587. doi:10.1161/CIRCEP.108.846022.PubMedCrossRef

52.

Spragg, D. D., Dong, J., Fetics, B. J., Helm, R., Marine, J. E., Cheng, A., et al. (2010). Optimal left ventricular endocardial pacing sites for cardiac resynchronization therapy in patients with ischemic cardiomyopathy. Journal of the American College of Cardiology, 56, 774–781. doi:10.1016/j.jacc.2010.06.014.PubMedCrossRef

53.

Jais, P., Takahashi, A., Garrigue, S., Yamane, T., Hocini, M., Shah, D. C., et al. (2000). Mid-term follow-up of endocardial biventricular pacing. Pacing and Clinical Electrophysiology, 23, 1744–1747.PubMed

54.

van Gelder, B. M., Scheffer, M. G., Meijer, A., & Bracke, F. A. (2007). Transseptal endocardial left ventricular pacing: an alternative technique for coronary sinus lead placement in cardiac resynchronization therapy. Heart Rhythm, 4, 454–460. doi:10.1016/j.hrthm.2006.11.023.PubMedCrossRef

55.

Kassai, I., Foldesi, C., Szekely, A., & Szili-Torok, T. (2009). Alternative method for cardiac resynchronization: transapical lead implantation. The Annals of Thoracic Surgery, 87, 650–652. doi:10.1016/j.athoracsur.2008.04.080.PubMedCrossRef

56.

Echt, D. S., Cowan, M. W., Riley, R. E., & Brisken, A. F. (2006). Feasibility and safety of a novel technology for pacing without leads. Heart Rhythm, 3, 1202–1206. doi:10.1016/j.hrthm.2006.06.012.PubMedCrossRef

57.

Soliman, O. I., Geleijnse, M. L., Theuns, D. A., van Dalen, B. M., Vletter, W. B., Jordaens, L. J., et al. (2009). Usefulness of left ventricular systolic dyssynchrony by real-time three-dimensional echocardiography to predict long-term response to cardiac resynchronization therapy. The American Journal of Cardiology, 103, 1586–1591. doi:10.1016/j.amjcard.2009.01.372.PubMedCrossRef

58.

Bax, J. J., Bleeker, G. B., Marwick, T. H., Molhoek, S. G., Boersma, E., Steendijk, P., et al. (2004). Left ventricular dyssynchrony predicts response and prognosis after cardiac resynchronization therapy. Journal of the American College of Cardiology, 44, 1834–1840. doi:10.1016/j.jacc.2004.08.016.PubMedCrossRef

59.

Yu, C. M., Lin, H., Zhang, Q., & Sanderson, J. E. (2003). High prevalence of left ventricular systolic and diastolic asynchrony in patients with congestive heart failure and normal QRS duration. Heart, 89, 54–60.PubMedCrossRef

60.

Suffoletto, M. S., Dohi, K., Cannesson, M., Saba, S., & Gorcsan, J., 3rd. (2006). Novel speckle-tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation, 113, 960–968. doi:10.1161/CIRCULATIONAHA.105.571455.PubMedCrossRef

61.

Jansen, A. H., van Dantzig, J., Bracke, F., Meijer, A., Peels, K. H., van den Brink, R. B., et al. (2007). Qualitative observation of left ventricular multiphasic septal motion and septal-to-lateral apical shuffle predicts left ventricular reverse remodeling after cardiac resynchronization therapy. The American Journal of Cardiology, 99, 966–969. doi:10.1016/j.amjcard.2006.11.044.PubMedCrossRef

62.

Buss, S. J., Humpert, P. M., Bekeredjian, R., Hardt, S. E., Zugck, C., Schellberg, D., et al. (2009). Echocardiographic phase imaging to predict reverse remodeling after cardiac resynchronization therapy. JACC. Cardiovascular Imaging, 2, 535–543. doi:10.1016/j.jcmg.2009.03.003.PubMedCrossRef

63.

Mills, R. W., Cornelussen, R. N., Mulligan, L. J., Strik, M., Rademakers, L. M., Skadsberg, N. D., et al. (2009). Left ventricular septal and left ventricular apical pacing chronically maintain cardiac contractile coordination, pump function and efficiency. Circulation. Arrhythmia and Electrophysiology, 2, 571–579. doi:10.1161/CIRCEP.109.882910.PubMedCrossRef

64.

Strauss, D. G., Selvester, R. H., & Wagner, G. S. (2011). Defining left bundle branch block in the era of cardiac resynchronization therapy. The American Journal of Cardiology, 107, 927–934. doi:10.1016/j.amjcard.2010.11.010.PubMedCrossRef

65.

Rademakers, L. M. (2009). Electrical and hemodynamic benefits of endocardial crt with chronic infarction and LBBB. Heart Rhythm, 6, S237.

Title: Electrical and Mechanical Ventricular Activation During Left Bundle Branch Block and Resynchronization
Authors: Marc Strik
François Regoli
Angelo Auricchio
Frits Prinzen
Publication date: 01-04-2012
Publisher: Springer US
Published in: Journal of Cardiovascular Translational Research / Issue 2/2012
Print ISSN: 1937-5387
Electronic ISSN: 1937-5395
DOI: https://doi.org/10.1007/s12265-012-9351-1

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