Epicardial activation in patients with left bundle branch block.

Wyndham, Christopher; Smith, Thomas C.; Meeran, M K; Mammana, Robert B.; Levitsky, Sidney; Rosen, Kenneth M.

doi:10.1161/01.cir.61.4.696

Cited by 87 publications

(29 citation statements)

References 28 publications

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“…However, in a few subjects it was earlier than normal. This observation is in accordance with the findings of Wyndham et al 6 and with the expectation that the earliest site of ventricular depolarization is on the right side of the septum in LBBB patients, as opposed to the left side in normal subjects. Thus, the earliest site of ventricular depolarization is closer to the site of right ventricular epicardial breakthrough, which leads to its earlier-than-normal appearance.…”

Section: Discussionsupporting

confidence: 93%

Comparison of total body surface map depolarization patterns of left bundle branch block and normal axis with left bundle branch block and left-axis deviation.

Sohi¹,

Flowers²,

Horan³

et al. 1983

Circulation

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Total body surface maps from 15 subjects with left bundle branch block and normal axis (LBBB-NA) and 10 subjects with left bundle branch block and left axis (LBBB-LA) were analyzed and compared with maps from normal subjects. In 19 of the 25 subjects with LBBB, the timing of early upper sternal positivity was similar to that of normal subjects, indicative of timely but oppositely directed septal activation. The right ventricular breakthrough was normally located in all, but was earlier after the onset of QRS than expected in some. The initial portion of the positivity produced by left ventricular activation was located in the upper anterior chest in both LBBB-NA and LBBB-LA, but its onset was generally delayed compared with that in normal subjects, presumably because of the time taken by the right-to-left septal activation. Also, the total duration of this positivity was longer than in normal subjects and extended considerably beyond 90 msec, indicating prolonged activation of the anterior free wall of the left ventricle. In LBBB-NA, this upper anterior positivity remained anterior throughout depolarization, but in LBBB-LA it moved toward the left shoulder and the left upper back, presumably due to the posterior orientation of the terminal portion of depolarization. This terminal orientation in patients with LBBB-LA was thought to be due to the additional delay in the activation of the anterobasal portion of the left ventricle caused by selective involvement of the left anterior fascicle.

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Section: Discussionsupporting

confidence: 93%

Comparison of total body surface map depolarization patterns of left bundle branch block and normal axis with left bundle branch block and left-axis deviation.

Sohi¹,

Flowers²,

Horan³

et al. 1983

Circulation

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“…Cardiol., 2011, 107, 927.) muscularis vezetés "csatlakozik" a subendocardialisan elhelyezkedő Purkinje-rendszerhez [18,19]. Auricchio és mtsai 2004-ben [20] konvencionális EKG-krité-riumok szerint BTSzB-snek minősített 24 betegben végeztek kontakt és nem kontakt 3D endocardialis mappinget.…”

Section: áBraunclassified

Results of the randomized studies on cardiac resynchronization therapy and the reevaluation of the cardiac ventricular activation in left bundle branch block

Préda

2013

Orvosi Hetilap

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A jelenleg érvényes irányelvek szerint szisztolés szívelégtelenség New York Heart Association II-IV. osztályaiban, ha a bal kamra ejekciós frakciója ≤35%, a QRS-komplexus ≥120 ms és az EKG bal-Tawara-szár-blokkot mutat, biventricularis pacemakerkezelés indikált. A szív reszinkronizációs kezelése és korábbi humán elektrofi ziológiai és patológiai adatok újraértelmezése azt mutatja, hogy ha a bal-Tawara-szár-blokkban mért QRS szélessége ≤130 ms (nőkben), illetve ≤140 ms (férfi akban), nem beszélhetünk valódi bal-Tawara-szár-blokkról. Ez utóbbiban az aszinkrón bal kamra-aktiváció jellemzője nőkben ≥130 ms, férfi akban ≥140 ms QRS-idő, a depolarizáció kezdetét >40 ms-mal követő csomós, kettős megtöretést mutató R-hullám az I, aVL és V 1 , V 2 , V 5 és V 6 EKG-elvezetés közül legalább kettőben, a korábban dokumentált nem szárblokkos ingerületvezetéshez képest ≥40 ms késés, ami hirtelen jön létre. Lassan, folyamatosan szélesedő bal-Tawara-szár-blokk-"szerű" QRS-komplexus bal mellső hemiblokk és hypertrophia együttesére vagy metabolikus/infi ltratív kóreredetre utal. Orv. Hetil., 2013, 154, 688-693. Kulcsszavak: szisztolés szívelégtelenség, szívreszinkronizációs kezelés (CRT), MADIT-CTR vizsgálat, bal-Tawaraszár-blokk-morfológia Results of the randomized studies on cardiac resynchronization therapy and the reevaluation of the cardiac ventricular activation in left bundle branch blockIf New York Heart Association Class II-IV heart failure is present, and ejection fraction ≤35%, electrocardiographic QRS width ≥ 120 ms in the presence of left bundle branch block, cardiac resynchronization therapy is indicated. Reevaluation of the data of cardiac resynchronization trials and electrophysiologic fi ndings in left bundle branch block provided evidence that "true" left bundle branch block requires a QRS width of ≥130 ms (in woman) and ≥140 ms (in man). In "true" left bundle branch block, after the 40th ms of the QRS notched/slurred R waves are characteristic in minimum two of I, aVL, V 1, V 2 , V 5 and V 6 leads, in addition to a ≥40 ms increase of the QRS complex, as compared to the original QRS complex. In contrast, slowly and continuously widened "left bundle branch block like" QRS patterns are mostly occur in left ventricular hypertrophy or in a metabolic/infi ltrative disease. Orv. Hetil., 2013, 154, 688-693. Keywords: systolic heart failure, cardiac resynchronization therapy (CRT), MADIT-CRT study, morphology of left bundle branch block (Beérkezett: 2013. március 4.; elfogadva: 2013. március 28.) Rövidítések BTSzB = bal-Tawara-szár-blokk; CRT = (cardiac resynchronization therapy) szívreszinkronizációs kezelés; EF = ejekciós frakció; NYHA = New York Heart Association

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“…2011;5 (4) left ventricle are the last regions to get depolarized (9,10). Therefore, when depolarization spreads through LV, the septum and anterior LV are the first-to-contract while the lateral wall contraction is delayed.…”

Section: Intra-ventricular Conduction Delay and Left Ventricular Dysfmentioning

confidence: 99%

Cardiac Resynchronisation Therapy in Heart Failure

Wahab¹,

Alvi²,

Panwar³

et al. 2011

Int Cardiovasc Res J

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This review is intended for those managing patients of heart failure and aims to provide the recent advances and emerging role of CRT implantation in heart failure management.Cardiac resynchronization therapy (CRT) represents one of the recent advances in heart failure (HF) management. It implies an attempt to establish left ventricular synchronous contraction in order to improve left ventricular hemodynamics; thereby improving functional class, and quality of life. CRT has come a long way from an incidental treatment modality to an accepted and indicated treatment strategy for patients suffering from severe and chronic heart failure. With its ever increasing use, it is important that we become conversant with its role in the management of heart failure. This article aims to review the evidence for CRT, how CRT benefits patients of heart failure and reveals the indications of CRT implantation in HF patients.

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Epicardial activation in patients with left bundle branch block.

Cited by 87 publications

References 28 publications

Comparison of total body surface map depolarization patterns of left bundle branch block and normal axis with left bundle branch block and left-axis deviation.

Comparison of total body surface map depolarization patterns of left bundle branch block and normal axis with left bundle branch block and left-axis deviation.

Results of the randomized studies on cardiac resynchronization therapy and the reevaluation of the cardiac ventricular activation in left bundle branch block

Cardiac Resynchronisation Therapy in Heart Failure

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