Dreidimensionale Vektorkardiographie zur CRT-Responderbestimmung

Abstract

Cardiac resynchronization therapy (CRT) is an accepted treatment for congestive heart failure (NYHA III-IV), but a substantial number of patients show no response to therapy. LBB, QRS width and echocardiographic measurements are parameters for indication, but they are not valid to predict hemodynamic response. A new method based on vector ECG analysis can deliver additional information, such as: parts or areas with late excitation, and with slow or fast depolarization speed. Electrical excitation is a prerequisite for contraction; this leads to the hypothesis that areas with late electrical activation will contract later. Algorithms for analysis of the vector ECG (determination of the vector -- time, area and speed) may help to identify responders and non-responders.

Cardiogoniometry can predict positive response to cardiac resynchronization therapy – A proof of concept study

“…The prognostic quality of the time interval between the maximum vector and the end of the vector loop showed to be relatively high with an excellent sensitivity for detection of responders in some studies 13 ,14. This may be due to delayed depolarization of final parts of the left ventricle (mostly the posterolateral wall) that prolong the time between maximum vector and terminal deflections of QRS 15 .…”

Fragmented QRS and Ventricular Dyssynchrony in a Patient Treated with Cardiac Resynchronization Therapy

“…However, this method is invasive and cannot be routinely performed. Another method to identify candidates for CRT using three-dimensional vectorcardiography has been described by Koglek et al [12]. They used vector ECG analysis to collect information for areas with late electrical excitation and slow or fast depolarization speed.…”