Heart ventricular activation in VAT difference maps from children with chronic kidney disease
Krystyna Laszki-Szczchor
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Dorota Polak-Jonkisz
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Danuta Zwoliska
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Lesaw Rusiecki
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Anna Janocha
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Magorzata Sobieszczaska
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A. Janocha Department of Physiology, Wroclaw Medical University
, Wroclaw,
Poland
1
) Department of Pathophysiology, Wroclaw Medical University
, Marcinkowskiego Street 1, 50-368 Wroclaw,
Poland
Children with chronic kidney disease (CKD) are affected by cardiovascular complications, including disturbances in the intraventricular conduction system. Body surface potential mapping (BSPM) is a non-invasive method of assessing the cardioelectrical field. Our aim was to investigate conduction disturbances in young CKD patients using ventricular activation time (VAT) maps. Our study comprised 22 CKD children (mean age: 13.1 2.5 years) treated conservatively and 29 control patients. For each child 12-lead electrocardiogram (ECG) readings were taken, and blood pressure and serum concentrations of iPTH, Pi, t-Ca, creatinine, Fe+3, ferritin, and Hb, as well as eGFR were measured. All children underwent registration in the 87-lead BSPM system, and group-mean VAT maps and a difference map, which presents statistically significant differences between the groups, were created. The VAT map distribution in CKD patients revealed abnormalities specific to left anterior fascicle block. The difference map displays the areas of intergroup VAT changes, which are of discriminative value in detecting intraventricular conduction disturbances. Intraventricular conduction impairments in the left bundle branch may occur in children with CKD. BSPM enables conduction disturbances in CKD children to be detected earlier than using 12-lead ECG. The difference map derived from the group-mean isochrone maps precisely localizes the sites of disturbed conduction in the heart intraventricular conduction system.
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There are numerous cardiovascular complications of
compound pathogenesis that appear in children with
conservatively treated chronic kidney disease (CKD). The causes of
these complications can be metabolic, hemodynamic, toxic,
humoral or vascular. Clinical observations indicate the
importance of arranging effective treatment for
cardiovascular disorders and predicting a prospective course of the
disease [1].
In our previous investigations concerning pediatric
patients with CKD, disorders in the heart intraventricular
conduction system were discovered using isointegral maps
[2].
Body surface potential mapping (BSPM) is one of the
electrocardiographic methods applied in modern cardiac
diagnostics. It enables the detection of various heart
abnormalities, as shown by many investigators, including
Miyashita and Okano, and Green and Abildskov [3, 4].
Some reports have stated that BSPM is clinically useful in
the early and precise diagnosis of intraventricular
conduction disturbances, owing to its superiority over standard
12lead ECG [5].
The BSPM technique is based upon simultaneous
registering of electrocardiographic signals from a
multielectrode body surface array. Electrodes cover the surface of
the thorax, which enhances the possibility of detecting local
events in the electrocardiographic field. The large number
of recording electrode sites results in higher sensitivity of
BSPM, giving it an advantage over standard ECG. The
results of BSPM examinations are displayed graphically in
the form of so-called heart maps, which comprise three
different types: isochrone, isopotential, and isointegral. The
first map reflects the propagation of the heart depolarization
over the thoracic surfaces in time, the second shows the
distribution of the instant heart potential over the thorax,
and the third type depicts resultant potential fluctuations
occurring within the given time intervals of the cardiac
cycle (area under the ECG curve).
In the present study we used isochrone maps, which
reflect the body surface distribution of ventricular activation
time (VAT) isolines. The isochrones are lines connecting all
sites of the myocardium that are activated at the same time,
and isochrone maps (or VAT maps) provide general
information about the ventricular activation sequence. The
distribution and values of isochrone maps precisely reflect
the time of ventricular activation propagation [35].
In order to extract divergences between the VAT maps of
the two groups examined, i.e., children with CKD and
children without CKD, a difference map was created.
The aim of the present study was to investigate possible
intraventricular conduction disturbances in young patients
with CKD using VAT maps.
Patients and methods
A group of 22 children with CKD (mean age: 13.12.5 years)
treated conservatively, were recruited to the study and
constituted Group S. These 22 children were subdivided
according to CKD progression, following the K/DOQI 2002
guidelines [6]. Of the study patients, 18 were at the third
stage of CKD and the remaining 4 were at the second stage.
The duration of third-stage CKD was 2.37.1 years (mean:
4.941.48 years), and (...truncated)