Abstract
Right heart failure is a common feature in patients with repaired tetralogy of Fallot (TOF), right ventricular (RV) dysfunction and right bundle branch block (RBBB). Biventricular pacing has been described as a potentially useful therapeutic in some cases. We aimed to investigate the changes in electrical epicardic activation using non invasive electrocardiographic imaging (ECGI) in different pacing configurations. eight adults with TOF, clinical signs of RV dysfunction and RBBB underwent implantation of a BVP device. Electrocardiographic imaging (ECGI) was applied during intrinsic activation (IA), right ventricular (RV) stimulation and BVP. 1) In spontaneous rhythm, the activation maps were compatible with a RBBB aspect with major dispersion of the activation of the right ventricle (RV activation time 114 ± 38 ms). 2) In RV pacing, right ventricular activation time is shorter but left ventricular activation is significantly delayed (110 ± 27 vs 72 ± 22 ms, p < 0,05). During BVP, the activation maps demonstrated reduction in the activation of the right ventricle without alteration of the activation of the left ventricle. 3) Global activation times in BVP are significantly reduced compared to sinus rhythm and RV pacing (122 ± 20 vs 147 ± 28 ms, p < 0,05). ECGI can be useful to assess non invasively the synchrony and electrophysiological substrate of patients with complex congenital heart disease. Activation maps, anterior view
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