[CRT-FORUM] 61S Predictive value of the electrical axis. Dr. Cagnolatti

[CRT-INFO]

Thank you for your comment, dear Dr. Perez Riera, I guess you know the
"iiiiiiimpeeerio"! I would like to know your opinion about an article by Dr.
Garcia Seara, that includes a number of 70 and some patients for CRT, and
mentions the favorable response to the implantation of the LV electrode in
the cases in which the electrical axis is shifted to the left, by placing an
LV catheter in the anterior region. (revista española de
cardiologia 2008;61:1245-8)

Dr. Alfredo Cagnolatti
> Dear colleague Dr. Alfredo Cagnolatti from “the empire” (el
> iiiiiiiiiiiiimperio en cordoooobé.
>
> We group together LBBB according to electrical axis in the FP as 
> following:
> 1) With SÂQRS not deviated: between -30 and +60 degree (65 to 70% of 
> cases)
>
> 2) With SÂQRS with extreme left-axis deviation (LAD): beyond –30 degree
> (25%)
>
> 3) With SÂQRS deviated to the right -axis deviation (RAD): between +60 
> and
> +90 degree (3.5 a 5% of cases)
>
> 4) With SÂQRS with extreme right -axis deviation: beyond +90 (<1%). It is
> named the "paradoxical of Lepeschkin" type.
>
> Biventricular pacing has been proposed for treating patients with drug
> refractory HF and intraventricular conduction delay. The purpose is to
> restore ventricular relaxation and contraction sequences as 
> homogeneously as
> possible. Alonso et al (1) studied if some ECG factors could predict the
> long-term clinical effectiveness of biventricular pacing. The study 
> included
> 26 patients, aged 66 +/- 7 years, with drug refractory HF and wide 
> LBBB QRS
> complex. Patients were implanted with a biventricular pacemaker. The 
> LV was
> paced through a coronary sinus tributary. NYHA functional class, exercise
> tolerance, and LVEF were collected at baseline and after pacemaker
> implantation.
> Patients were divided into 2 groups:
> Group I = responders
> Group II = non-responders
> QRSd and QRS axis at baseline and during biventricular pacing,
> interventricular conduction time, and LV and RV lead positions were 
> compared
> between the 2 groups. Group I patients (n = 19) had a mean reduction 
> of 1.3
> in functional class and an increase in peak oxygen consumption rate by a
> mean of 50%. The only parameter that differed between the 2 groups was 
> the
> QRSd during biventricular pacing, with a significantly shorter value in
> group I than in group II. Thus, a positive response to biventricular 
> pacing
> is correlated with the quality of electrical resynchronization. The 
> optimal
> positions of the right and LV leads would be those that could induce the
> greatest shortening of QRSd.
> Reference
> 1) Alonso C, Leclercq C, Victor F, Mansour H, de Place C, Pavin D,
> Carré F, Mabo P, Daubert JC. Electrocardiographic predictive factors of
> long-term clinical improvement with multisite biventricular pacing in
> advanced heart failure Am J Cardiol. 1999 Dec 15; 84:1417-1421.
>
> All the best for all
> Andrés Ricardo Pérez Riera.MD
> Chief of electrovectorcardiographic sector. ABC’s Medical School, ABC
> Foundation, Santo André, São Paulo, Brazil Riera at uol.com.br
>> Congratulations to the steering committee and the sponsors of this 
>> forum. I
>> seize this opportunity to ask the experts what is the predictive 
>> value as to
>> responders and non-responders, of the shift of the axis with left bundle
>> branch block to the left, or left bundle branch block with normal 
>> axis in
>> the location of the LV lead, whether to place it in the anterior or the
>> postero-lateral region.
>>
>> Dr. Alfredo Cagnolatti
>> Rio Cuarto
>> Cordoba - Argentina
>>
>
>


-- 
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee