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Vectorcardiography as a Tool for Easy Optimization of
Cardiac Resynchronization Therapy in Canine Left Bundle
Branch Block HeartsClinical Perspective
by Caroline J.M. van Deursen, Marc Strik, Leonard M. Rademakers, Arne van
Hunnik, Marion Kuiper, Liliane Wecke, Harry J.G.M Crijns, Kevin Vernooy, and Frits
W. Prinzen
Circ Arrhythm Electrophysiol
Volume 5(3):544-552
June 19, 2012
Copyright © American Heart Association, Inc. All rights reserved.
Mean frontal plane angle of the maximal QRS vector amplitude during intrinsic conduction
(LBBB) and during LV pacing with short AV delay at different pacing sites.
Caroline J.M. van Deursen et al. Circ Arrhythm
Electrophysiol. 2012;5:544-552
Copyright © American Heart Association, Inc. All rights reserved.
ECG (lead aVF; upper panel), vectorcardiogram (VCG, frontal plane; middle panel), and
normalized pressure curves of the right (RV) and left ventricle (LV; lower panel), while stepwise
increasing AV delay during LV pacing.
Caroline J.M. van Deursen et al. Circ Arrhythm
Electrophysiol. 2012;5:544-552
Copyright © American Heart Association, Inc. All rights reserved.
Changes in mechanical interventricular dyssynchrony (MIVD) and QRS vector amplitude
(VAQRS) as a function of the paced atrioventricular (AV) delay (A), with their corresponding
linear relation (B) during left ventricular (LV) pacing at the basal lateral wall in a canine heart
with left bundle branch block (LBBB) and heart failure.
Caroline J.M. van Deursen et al. Circ Arrhythm
Electrophysiol. 2012;5:544-552
Copyright © American Heart Association, Inc. All rights reserved.
Dot plot showing the mean correlation coefficients per animal between QRS vector amplitude
(VAQRS ) and mechanical interventricular dyssynchrony (MIVD) for anterior pacing sites (Ant),
lateral pacing sites (Lat), posterior sites (Post), and apical sites (Apex).
Caroline J.M. van Deursen et al. Circ Arrhythm
Electrophysiol. 2012;5:544-552
Copyright © American Heart Association, Inc. All rights reserved.
Combined data of all models and pacing sites showing that for QRS vector amplitude (left panel)
as well as for mechanical interventricular dyssynchrony (right panel), the values at the optimal
AV delay are in between that of pacing with short AV delay and left bundle branch block.
Caroline J.M. van Deursen et al. Circ Arrhythm
Electrophysiol. 2012;5:544-552
Copyright © American Heart Association, Inc. All rights reserved.
Correlation between the observed atrioventricular (AV) delay resulting in maximal increase in
∆LV dP/dtmax (relative to baseline left bundle branch block), and the AV delay predicted by the
“halfway value” of the QRS vector amplitude (panel A), and the AV delay predicted by narrowest
QRS (panel C).
Caroline J.M. van Deursen et al. Circ Arrhythm
Electrophysiol. 2012;5:544-552
Copyright © American Heart Association, Inc. All rights reserved.
Observed (black bars) optimal atrioventricular (AV) delay that resulted in maximal increase in
∆LV dP/dtmax per group versus the vectorcardiogram (VCG) predicted optimal AV delay (gray
bars; left panel).
Caroline J.M. van Deursen et al. Circ Arrhythm
Electrophysiol. 2012;5:544-552
Copyright © American Heart Association, Inc. All rights reserved.
QRS vector amplitude (VAQRS) and corresponding ∆LV dP/dtmax for biventricular (BiV) pacing
at various atrioventricular (AV) delays in an animal at which the halfway value of VAQRS was
reachable (appropriate AV optimization; left upper panel) and in an animal where it was not
reachable (inappropriate AV optimization; right upper panel).
Caroline J.M. van Deursen et al. Circ Arrhythm
Electrophysiol. 2012;5:544-552
Copyright © American Heart Association, Inc. All rights reserved.