Page 150 - YORAM RUDY BOOK FINAL

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Figure 5.13. Epicardial activation of
native rhythm in four representative
HF patients (A-D) and in a normal
heart (E). Three views are shown for
each heart, as indicated at the
bottom. The thick black lines
indicate conduction block. All HF
maps show RV activation first,
followed by greatly delayed and
heterogeneous LV activation. RV
epicardial activation is normal,
starting at a typical normal RV break-
through site (RVB). Normal activation
(bottom panel) is highly synchronized,
without delays or blocks. Numbers
indicate activation times (from QRS
onset); earliest and latest activation
times are highlighted by frames.
QRSd: QRS duration. From Jia et. al.
[304] with permission of Elsevier.

This information could be obtained noninvasively with ECGI. Figure 5.14 is an example of
ECGI-guided LV electrode placement in a pediatric HF patient with congenital heart disease 307 .

Responders to CRT

Figure 5.15 shows ECGI activation maps during native rhythm and BiV pacing (top and
bottom row of each panel, respectively). Maps are shown for two patients, patient #5 (panel A)
and patient #3 (panel B). Both patients respond to CRT. The LV pacing lead in patient #5 was
placed at the lateral wall (Figure 5.15A, bottom; the white asterisk marks the electrode position).
The paced wave front captured most of the LV and eliminated the very late activation region