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(Circulation. 2003;107:2761.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Electroanatomic Mapping of Cardiac Resynchronization Therapy

Vivek Y. Reddy, MD; Petr Neuzil, MD; Milos Taborsky, MD; Stepan Kralovec;; Lucie Sedivá, MD; Jeremy N. Ruskin, MD

From the Cardiac Arrhythmia Services of Massachusetts General Hospital–Harvard Medical School, Boston, Mass (J.N.R., V.Y.R.), and Na Homolce Hospital, Prague, Czech Republic (P.N., M.T., S.K., L.S.).

Correspondence to Vivek Y. Reddy, MD, Cardiac Arrhythmia Service, Massachusetts General Hospital, 55 Fruit St, GRB 109, Boston, MA 02114. E-mail vreddy@partners.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

A 51-year-old man with a history of dilated cardiomyopathy presented with New York Heart Association Class III congestive heart failure. Despite optimal medical management, he continued to experience symptoms consistent with low-output failure: exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. He was hospitalized 3 times in the previous 4 months for congestive heart failure management. The baseline ECG revealed a left bundle-branch block with a QRS width of 172 ms, and the echocardiogram revealed an ejection fraction of 28%. He was referred to the cardiac arrhythmia service for cardiac resynchronization therapy. A biventricular pacemaker was implanted in the left prepectoral region. A transvenous approach was utilized to position both the standard right-sided leads, and the left ventricular lead was positioned via the coronary sinus (Figure 1).

View larger version (137K): [in this window] [in a new window]   Figure 1. Fluoroscopic position of the cardiac pacing leads. The pacing leads were positioned at the right atrial appendage (RAA), right ventricular apex (RV) and a posterolateral branch of the coronary sinus (LV). The unipolar LV pacing lead was placed by using a transvenous approach after retrogradely engaging the ostium of the coronary sinus with a long sheath.

Two months after implantation of the biventricular pacing system, the patient underwent electroanatomic mapping of both ventricles during an electrophysiological study. Electroanatomic mapping revealed a significant change in the electrical activation pattern during either right ventricular (Figure 2) or biventricular (Figure 3) pacing. As compared with right ventricular pacing alone (Figure 2), biventricular pacing resulted in a concomitant . . . [Full Text of this Article]