Heart ventricular activation in VAT difference maps from children with chronic kidney disease

Pediatric Nephrology, Aug 2011

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.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://link.springer.com/content/pdf/10.1007%2Fs00467-011-1982-y.pdf

Heart ventricular activation in VAT difference maps from children with chronic kidney disease

Krystyna Laszki-Szczchor 0 Dorota Polak-Jonkisz 0 Danuta Zwoliska 0 Lesaw Rusiecki 0 Anna Janocha 0 Magorzata Sobieszczaska 0 0 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. - 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)


This is a preview of a remote PDF: https://link.springer.com/content/pdf/10.1007%2Fs00467-011-1982-y.pdf

Krystyna Laszki-Szcząchor, Dorota Polak-Jonkisz, Danuta Zwolińska, Lesław Rusiecki, Anna Janocha, Małgorzata Sobieszczańska. Heart ventricular activation in VAT difference maps from children with chronic kidney disease, Pediatric Nephrology, 2011, pp. 251-259, Volume 27, Issue 2, DOI: 10.1007/s00467-011-1982-y