Directed Transesophageal Left Atrial and Left Ventricular Electrocardiography in Evaluation of Interatrial and Interventricular Delay in Patients with Heart Failure

摘要

Cardiac resynchronisation therapy (CRT) by biventricular (BV) pacing is an established therapy for heart failure (HF) patients with ventricular desynchronisation, but not all patients improved clinically. The aim of the study was to assess directed transesophageal electrocardiography (ECG) of left atrial (LA) potential and left ventricular (LV) potential in evaluation of interatrial delay (IAD) and interventricular delay (IVD) in patients with HF. Methods: 45 HF patients (age 61 ± 12 years; 9 females, 36 males) in NYHA class 2.9 ± 0.4, 26 ± 9 % LV ejection fraction and 157 ± 40 ms QRS duration (QRSD) were analyzed IAD and IVD using directed transesophageal bipolar recording of the posterior LA and LV wall potentials with hemispherical electrodes. IAD was the right atrial - LA - interval between onset of P-wave in the surface ECG and onset of LA potential in the transesophageal ECG. IVD was the right ventricular -LV - interval between onset of QRS complex in the surface ECG and onset of LV potential in the transesophageal ECG. Results: Transesophageal IVD was smaller than transesophageal IAD (66 ± 32 ms vs. 82 ± 39 ms, P = 0.036) in HF patients with impaired LV function. Transesophageal IAD was smaller than QRSD (P < 0.001) and transesophageal IVD was also smaller than QRSD (P < 0.001). Enlarged left atria were smaller than enlarged left ventricles (48 ± 9 mm vs. 61 ± 9 mm, P < 0.001) in HF patients. Finite element simulation of electrical pacing field evaluated transesophageal directed electrical field electrodes. Conclusion: Directed transesophageal LA and LV ECG may detect IAD and IVD in symptomatic HF patients before implantation of BV pacing device. Transesophageal LA and LV ECG recording may be a useful non-invasive technique to detect atrial and ventricular desynchronisation in HF patients.