title: Coronary sinus activation patterns in patients with and without left bundle branch block undergoing electroanatomic mapping system-guided cardiac resynchronization therapy device implantation.
abstract: Implantation of the left ventricular (LV) lead in segments with delayed electrical activation may improve response to cardiac resynchronization therapy (CRT).
  
  
  
  The purpose of this study was to evaluate the amount and regional distribution of LV electrical delay (LVED) in patients with or without left bundle branch block (LBBB).
  
  
  
  We enrolled 60 patients who underwent electroanatomic mapping system-guided CRT device implantation. Activation mapping of the coronary sinus (CS) branches was performed using an insulated guidewire. LVED was defined as the interval between the beginning of the QRS complex on the surface electrocardiogram (ECG) and the local electrogram and expressed in milliseconds or as percentage of the total QRS duration (LVED%).
  
  
  
  Forty-three patients showed a LBBB and 17 a non-LBBB electrocardiographic pattern. A total of 148 CS branches (mean 2.5 per patient; range 2-4 per patient) were mapped. Patients with LBBB showed higher maximum LVED (135 ms [108-150 ms] vs 100 ms [103-110 ms]; P < .001) and LVED% (86% [79%-89%] vs 72% [54%-80%]; P < .001) than did patients without LBBB. The maximum LVED was recorded in mid-basal anterolateral or inferolateral LV segments (traditional CRT targets), significantly more often in patients with LBBB than in patients without LBBB (85% vs 59%; P = .02). The number of CS branches showing LVED >50% of the total QRS duration, >75% of the total QRS duration, and >85 ms was significantly higher in patients with LBBB than in patients without LBBB.
  
  
  
  Patients without LBBB showed lower LVED and more heterogeneous electrical activation of the CS than did patients with LBBB. This finding may contribute to a lower rate of response to CRT of patients without LBBB and suggests the use of activation mapping to guide LV lead placement.
authors.affiliation: Santa Maria del Carmine Hospital, Rovereto TN, Italy,. Electronic address: maurizio.delgreco@apss.tn.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Del Greco
authors.affiliation: Santa Maria del Carmine Hospital, Rovereto TN, Italy,; Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zorzi
authors.affiliation: Santa Maria del Carmine Hospital, Rovereto TN, Italy.
authors.forename: Irene
authors.initials: I
authors.lastname: Di Matteo
authors.affiliation: Santa Maria del Carmine Hospital, Rovereto TN, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Cima
authors.affiliation: Santa Maria del Carmine Hospital, Rovereto TN, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Maines
authors.affiliation: Santa Maria del Carmine Hospital, Rovereto TN, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Angheben
authors.affiliation: Santa Maria del Carmine Hospital, Rovereto TN, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Catanzariti
mesh_terms: D000368:Aged; D018780:Body Surface Potential Mapping / Q000379:methods*; D002037:Bundle-Branch Block / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000379:methods; D058409:Cardiac Resynchronization Therapy Devices; D054326:Coronary Sinus / Q000503:physiopathology*; D004558:Electric Stimulation / Q000295:instrumentation / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D025321:Surgery, Computer-Assisted / Q000379:methods
keywords: Cardiac resynchronization therapy; Electroanatomic mapping system; Heart failure; Implantable cardioverter-defibrillator; Left bundle branch block