title: Right and left ventricular activation sequence in patients with heart failure and right bundle branch block: a detailed analysis using three-dimensional non-fluoroscopic electroanatomic mapping system.
abstract: Three-dimensional mapping in RBBB and heart failure.
  
  
  BACKGROUND
  Recently, right bundle branch block (RBBB) was proved to be an important predictor of mortality in heart failure (HF) patients as much as left bundle branch block (LBBB). We characterized endocardial right ventricular (RV) and left ventricular (LV) activation sequence in HF patients with RBBB using a three-dimensional non-fluoroscopic electroanatomic contact mapping system (3D-Map) in order to provide the electrophysiological background to understand whether these patients can benefit from cardiac resynchronization therapy (CRT).
  
  
  RESULTS
  Using 3D-Map, RV and LV activation sequences were studied in 100 consecutive HF patients. Six of these patients presented with RBBB QRS morphology. The maps of these patients were analyzed and compared post hoc with those of the other 94 HF patients presenting with LBBB. Clinical and hemodynamic profile was significantly worse in RBBB group compared to LBBB. Patients with RBBB showed significantly longer time to RV breakthrough (P<0.001), longer activation times of RV anterior and lateral regions (P<0.001), and longer total RV endocardial activation time (P<0.02) compared to patients with LBBB. Time to LV breakthrough was significantly shorter in patients with RBBB (P<0.001), while total and regional LV endocardial activation times were not significantly different between the two groups.
  
  
  CONCLUSIONS
  Degree of LV activation delay is similar between HF patients with LBBB and RBBB. Moreover, patients with RBBB have larger right-sided conduction delay compared to patients with LBBB. The assessment of these electrical abnormalities is important to understand the rationale for delivering CRT in HF patients with RBBB.
authors.affiliation: Division of Cardiology, University Hospital, Magdeburg, Germany. ceciliafantoni@yahoo.com
authors.forename: Cecilia
authors.initials: C
authors.lastname: Fantoni
authors.forename: Mihoko
authors.initials: M
authors.lastname: Kawabata
authors.forename: Raimondo
authors.initials: R
authors.lastname: Massaro
authors.forename: Francois
authors.initials: F
authors.lastname: Regoli
authors.forename: Santi
authors.initials: S
authors.lastname: Raffa
authors.forename: Vanita
authors.initials: V
authors.lastname: Arora
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Salerno-Uriarte
authors.forename: Helmut U
authors.initials: HU
authors.lastname: Klein
authors.forename: Angelo
authors.initials: A
authors.lastname: Auricchio
mesh_terms: D000368:Aged; D018780:Body Surface Potential Mapping / Q000379:methods*; D002037:Bundle-Branch Block / Q000503:physiopathology*; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006333:Heart Failure / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged