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Figure 2 (Top) Ventricular activation sequence (right anterior oblique view [Ant]) using three-dimensional noncontact mapping (EnSite 3000, Endocardial Solutions) in a patient with ischemic cardiomyopathy (left ventricular [LV] ejection fraction [EF] 35%, New York Heart Association functional class III) with a QRS duration of 148 ms who did not respond to cardiac resynchronization therapy (CRT). (Bottom) Ventricular activation sequence (posterior view [POST]). There was no line of block or acute change in propagation direction of the depolarization wavefront detected by the mapping system. Of note, there were differences in the electrocardiogram (ECG) pattern between this patient and the patient displayed in Figure 1, indicating that the surface ECG fails to predict the activation sequences in these patients. The prolonged LV activation time in this patient may be due to the relatively slow conduction velocity in the myocardium. The LV lead was positioned in the posterolateral vein. One year after CRT, the LVEF was 34% and the clinical status of the patient unchanged.
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