Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response: site of latest left ventricular activation relative to pacing site
Parreira, Leonor; Tsyganov, Alexey; Artyukhina, Elena; Vernooy, Kevin; Tondo, Claudio; Adragao, Pedro; Ascione, Ciro; Carmo, Pedro; Carvalho, Salomé; Egger, Matthias; Ferreira, Antonio; Ghossein, Mohammed; Holm, Magnus; Kalinin, Vitaly; Malakhova, Maria; Meine, Mathias; Nunes, Silvia; Podolyak, Dmitry; Revishvili, Amiran; Shapieva, Albina; Stepanova, Vera; van Stipdonk, Antonius; Taymasova, Irina; Wouters, Philippe; Zubarev, Stepan; Leyva, Francisco; Auricchio, Angelo; Varma, Niraj
(2023) Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, volume 25, issue 4, pp. 1458 - 1466
(Article)
Abstract
AIMS: Pacing remote from the latest electrically activated site (LEAS) in the left ventricle (LV) may diminish response to cardiac resynchronization therapy (CRT). We tested whether proximity of LV pacing site (LVPS) to LEAS, determined by non-invasive three-dimensional electrical activation mapping [electrocardiographic Imaging (ECGI)], increased likelihood of CRT response. METHODS
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AND RESULTS: Consecutive CRT patients underwent ECGI and chest/heart computed tomography 6-24 months of post-implant. Latest electrically activated site and the distance to LVPS (dp) were assessed. Left ventricular end-systolic volume (LVESV) reduction of ≥15% at clinical follow-up defined response. Logistic regression probabilistically modelled non-response; variables included demographics, heart failure classification, left bundle branch block (LBBB), ischaemic heart disease (IHD), atrial fibrillation, QRS duration, baseline ejection fraction (EF) and LVESV, comorbidities, use of CRT optimization algorithm, angiotensin-converting enzyme inhibitor(ACE)/angiotensin-receptor blocker (ARB), beta-blocker, diuretics, and dp. Of 111 studied patients [64 ± 11 years, EF 28 ± 6%, implant duration 12 ± 5 months (mean ± SD), 98% had LBBB, 38% IHD], 67% responded at 10 ± 3 months post CRT-implant. Latest electrically activated sites were outside the mid-to-basal lateral segments in 35% of the patients. dp was 42 ± 23 mm [31 ± 14 mm for responders vs. 63 ± 24 mm non-responders (P < 0.001)]. Longer dp and the lack of use of CRT optimization algorithm were the only independent predictors of non-response [area under the curve (AUC) 0.906]. dp of 47 mm delineated responders and non-responders (AUC 0.931). CONCLUSION: The distance between LV pacing site and latest electrical activation is a strong independent predictor for CRT response. Non-invasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.
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Keywords: Cardiac resynchronization therapy, Dilated cardiomyopathy, ECGI, Electrocardiographic imaging, Heart failure, Ischaemic cardiomyopathy, Non-invasive 3D electrical activation mapping, Cardiology and Cardiovascular Medicine, Physiology (medical), Journal Article
ISSN: 1099-5129
Publisher: Oxford University Press
Note: Funding Information: The study was sponsored by EP Solutions SA, CH-1400, Yverdon-les-Bains, Switzerland. Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com.
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