Characterizing left ventricular mechanical and electrical activation in patients with normal and impaired systolic function using a non-fluoroscopic cardiovascular navigation system
Cardiac disease frequently has a degenerative effect on cardiac pump function and regional myocardial contraction. Therefore, an accurate assessment of regional wall motion is a measure of the extent and severity of the disease. We sought to further validate an intra-operative, sensor-based technology for measuring wall motion and strain by characterizing left ventricular (LV) mechanical and electrical activation patterns in patients with normal (NSF) and impaired systolic function (ISF).
NSF (n = 10; ejection fraction = 62.9 ± 6.1%) and ISF (n = 18; ejection fraction = 35.1 ± 13.6%) patients underwent simultaneous electrical and motion mapping of the LV endocardium using electroanatomical mapping and navigational systems (EnSite™ NavX™ and MediGuide™, Abbott). Motion trajectories, strain profiles, and activation times were calculated over the six standard LV walls.
NSF patients had significantly greater motion and systolic strains across all LV walls than ISF patients. LV walls with low-voltage areas showed less motion and systolic strain than walls with normal voltage. LV electrical dyssynchrony was significantly smaller in NSF and ISF patients with narrow-QRS complexes than ISF patients with wide-QRS complexes, but mechanical dyssynchrony was larger in all ISF patients than NSF patients. The latest mechanical activation was most often the lateral/posterior walls in NSF and wide-QRS ISF patients but varied in narrow-QRS ISF patients.
This intra-operative technique can be used to characterize LV wall motion and strain in patients with impaired systolic function. This technique may be utilized clinically to provide individually tailored LV lead positioning at the region of latest mechanical activation for patients undergoing cardiac resynchronization therapy.
Clinical trial registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01629160.
KeywordsLeft ventricular wall motion Left ventricular strain Electrophysiology mapping Dyssynchrony Cardiac resynchronization therapy
This study was sponsored by Abbott, Inc.
Compliance with ethical standards
CP has received modest lecture honoraria from Abbott, Biotronik, Boehringer Ingelheim, and Biosense Webster, is a member of the Abbott, Siemens and Biosense Webster advisory boards, and has received research support from Abbott, Biotronik, Imricor, and Philips. CM, CJ, SR, and KR are employed by Abbott with ownership interests. OAB has received modest lecture honoraria from Abbott, Biotronik, Medtronic and GE Healthcare. S. Rolf and S. Richter have received modest lecture honoraria from Abbott, Biotronik, and Boehringer Ingelheim. FWP serves as a consultant for Abbott and has received research grants from Medtronic, Boston Scientific, EBR Systems, Biological Delivery System Cordis, Abbott, Sorin, Biotronik, MSD, and Proteus Biomedical. GH has received modest lecture honoraria from Abbott, Inc., Biotronik, Medtronic, and Biosense Webster and is a member of the Abbott and Biosense Webster advisory board. PS received modest lecture honoraria from Abbott, Biotronik, Biosense Webster, and Abbott and is a member of the Abbott advisory board. The other authors have no conflicts of interest to disclose.
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