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Coupling of ventricular action potential duration and local strain patterns during reverse remodeling in responders and non-responders to cardiac resynchronization therapy

Chen, Z; Hanson, B; Sohal, M; Sammut, E; Jackson, T; Child, N; Claridge, S; ... Taggart, P; + view all (2016) Coupling of ventricular action potential duration and local strain patterns during reverse remodeling in responders and non-responders to cardiac resynchronization therapy. Heart Rhythm , 13 (9) pp. 1898-1904. 10.1016/j.hrthm.2016.06.014. Green open access

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Abstract

BACKGROUND: The high risk of ventricular arrhythmias in heart failure patients remains despite the benefit of cardiac resynchronization therapy (CRT). An electromechanical interaction between regional myocardial strain patterns and the electrophysiological substrate is thought to be important. OBJECTIVE: We investigated the in-vivo relation between left ventricular (LV) activation recovery interval (ARI), as a surrogate measure of activation potential duration (APD), and local myocardial strain patterns in responders and non-responders to CRT. METHODS: ARI were recorded from the left ventricular epicardium in 20 CRT patients 6 weeks and 6 months post implant. Two-dimensional speckle tracking echocardiography was performed at the same time to assess myocardial strains. Patients with ≥15% reduction in end-systolic volume at 6-months were classified as responders. RESULTS: ARI reduced in responders, 263±46ms vs. 246±47ms, p<0.01; and increased in non-responders, 235±23ms vs. 261±20ms, p<0.01. Time-to-peak (TPS) radial, circumferential and longitudinal strains increased in responders (+41±27ms, +35±25ms, +56±37ms; p<0.01); and reduced in non-responders (-58±26ms, -47±26ms, -64±27ms; p<0.01). There was a non-linear correlation between changes in TPS and ARI (r≥0.70; p<0.01). Baseline QRS >145ms and QRS shortening with biventricular pacing was associated with ARI shortening during CRT. CONCLUSIONS: Changes in ventricular wall mechanics predict local APD lengthening or shortening during CRT. Non-responders have a worsening of myocardial strain and local APD. Baseline QRS >145ms and QRS shortening on biventricular pacing identified patients who exhibited improvement in APD.

Type: Article
Title: Coupling of ventricular action potential duration and local strain patterns during reverse remodeling in responders and non-responders to cardiac resynchronization therapy
Open access status: An open access version is available from UCL Discovery
DOI: 10.1016/j.hrthm.2016.06.014
Publisher version: http://doi.org/10.1016/j.hrthm.2016.06.014
Language: English
Additional information: Copyright © 2016 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/. The final published article is available from the journal website at http://www.sciencedirect.com/science/article/pii/S1547527116304143
Keywords: Cardiac remodeling, action potential duration, activation recovery interval, cardiac resynchronization therapy, myocardial strain
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Engineering Science > Dept of Mechanical Engineering
URI: https://discovery.ucl.ac.uk/id/eprint/1498932
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