Electro-mechanical Assessment of Left Ventricle Rotation

Tomasz Jadczyk Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, Poland Radoslaw Kurzelowski Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, Poland Krzysztof Golba Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland Jacek Wilczek Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland Jolanta Biernat Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland Magdalena Cybulska Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland Maximilian Emmert Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany Barbara Kalanska Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, Poland Zofia Parma Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, Poland Kamil Baranski Department of Epidemiology, Medical University of Silesia, Katowice, Poland Mieczyslaw Dutka Department of Biochemistry and Molecular Biology, Faculty of Health Sciences,, University of Bielsko-Biala, Bielsko-Biała, Poland Guido Caluori Nanobiotechnology, CEITEC Masaryk University, Brno, Czech Republic Zdenek Starek Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital Brno, Czech Republic Wojciech Wojakowski Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Katowice, Poland

Background: Limited information about the electro-mechanical (EM) characteristics of left ventricle (LV) is available.

Objectives: To evaluate LV rotation in heart failure (HF) patients with left bundle branch block (LBBB) using the NOGA®XPsystem.

Methods: 30 patients with HF/LBBB (QRS duration > 150 ms) underwent EM mapping of LV with a multiscale analysis of: (1) LV peak and (2) mean torsion; (3) Rotation angle; (4) Rotation rate; (5) Interventricular delay; (6) LV electrical activation time; (7) LV electrical cycle length; (8) LV mechanical cycle length; (9) Unipolar voltage; (10) Bipolar voltage; (11) Local activation time; (12) Local rotational electro-mechanical delay, LEMD;(13) LV rotational electro-mechanical delay; (14) Total rotational electro-mechanical delay, TEMD.

Results: LV mechanics was classified into 2 categories: wringingrotation (Group A, n=6) and rigid body-type rotation (Group B, n=24). Globally, there were no significant EM differencesbetween groups except for higher unipolar and bipolar voltage in Group B. Segmental analysis in Group B revealed significant differences in LEMD between apical and posterobasal segments, whereas TEMD propagation pattern showed that contraction originates from postero-septal segments, with a second front in the antero-lateral ones passing from the apex. On contrary, Group A did not present significant differences in LEMD across LV segments, while TEMD sequence indicated mid-anterior origin of the contraction traveling towards the apex.

Conclusions: Two types of LV rotation in HF/LBBB patientswere characterized via multiscale electro-mechanical mapping and analysis (NOGA®XP), suggesting that the determination of the rotation pattern lies in the local alteration of EM coupling.