electrical activation in the coronary sinus branches as a guide to cardiac resynchronisation therapy rationale for a coordinate system电激活的冠状静脉窦分支作为指导心脏同步模式治疗的理由一个坐标系统.pdfVIP

Electrical Activation in the Coronary Sinus Branches as a Guide to Cardiac Resynchronisation Therapy: Rationale for a Coordinate System 1,2 1 1 1 ¨ 1 Christoph Scharf *, Nazmi Krasniqi , Jens Hellermann , Mariette Rahn , Gabor Sutsch , Corinna Brunckhorst1, Firat Duru1,3 1 Division of Pacing and Electrophysiology, Clinic for Cardiology, Cardiovascular Center, University Hospital Zurich, Zurich, Switzerland, 2 Cardiology, Clinic im Park, Zurich, Switzerland, 3 Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland Abstract Background: For successful cardiac resynchronisation therapy (CRT) a spatial and electrical separation of right and left ventricular electrodes is essential. The spatial distribution of electrical delays within the coronary sinus (CS) tributaries has not yet been identified. Objective: Electrical delays within the CS are described during sinus rhythm (SR) and right ventricular pacing (RVP). A coordinate system grading the mitral ring from 0u to 360u and three vertical segments is proposed to define the lead positions irrespective of individual CS branch orientation. Methods: In 13 patients undergoing implantation of a CRT device 662.5, (median 5) lead positions within the CS were mapped during SR and RVP. The delay to the onset and the peak of the local signal was measured from the earliest QRS activation or the pacing spike. Fluoroscopic positions were compared to localizations on a nonfluoroscopic electrode imaging system. Results: During SR, electrical delays in the CS were inhomogenous in patients with or without left bundle branch block (LBBB). During RVP, the delays increased by 44632 ms (signal onset fro