Cardiac electrical dyssynchrony is accurately detected by noninvasive electrocardiographic imaging

Laura R. Bear*, Peter R. Huntjens, Richard D. Walton, Olivier Bernus, Ruben Coronel, Remi Dubois

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

36 Citations (Web of Science)

Abstract

BACKGROUND Poor identification of electrical dyssynchrony is postulated to be a major factor contributing to the low success rate for cardiac resynchronization therapy. OBJECTIVE The purpose of this study was to evaluate the sensitivity of body surface mapping and electrocardiographic imaging (ECGi) to detect electrical dyssynchrony noninvasively. METHODS Langendorff-perfused pig hearts (n = 11) were suspended in a human torso-shaped tank, with left bundle branch block (LBBB) induced through ablation. Recordings were taken simultaneously from a 108-electrode epicardial sock and 128 electrodes embedded in the tank surface during sinus rhythm and ventricular pacing. Computed tomography provided electrode and heart positions in the tank. Epicardial unipolar electrograms were reconstructed from torso potentials using ECGi. Dyssynchrony markers from torso potentials (eg, QRS duration) or ECGi (total activation time, interventricular delay [D-LR], and intraventricular markers) were correlated with those recorded from the sock. RESULTS LBBB was induced (n = 8), and sock-derived activation maps demonstrated interventricular dyssynchrony (D-LR and total activation time) in all cases (P < .05) and intraventricular dyssynchrony for complete LBBB (P < .05) compared to normal sinus rhythm. Only D-LR returned to normal with biventricular pacing (P = .1). Torso markers increased with large degrees of dyssynchrony, and no reduction was seen during biventricular pacing (P > .05). Although ECGi-derived markers were significantly lower than recorded (P < .05), there was a significant strong linear relationship between ECGi and recorded values. ECGi correctly diagnosed electrical dyssynchrony and interventricular resynchronization in all cases. The latest site of activation was identified to 9.1 +/- 0.6 mm by ECGi. CONCLUSION ECGi reliably and accurately detects electrical dyssynchrony, resynchronization by biventricular pacing, and the site of latest activation, providing more information than do body surface potentials.
Original languageEnglish
Pages (from-to)1058-1069
Number of pages12
JournalHeart Rhythm
Volume15
Issue number7
DOIs
Publication statusPublished - 1 Jul 2018

Keywords

  • CRT
  • Electrocardiography
  • ECGI
  • LBBB
  • Noninvasive electrocardiographic imaging
  • BUNDLE-BRANCH-BLOCK
  • RESYNCHRONIZATION THERAPY
  • HEART-FAILURE
  • EPICARDIAL POTENTIALS
  • PATIENT SELECTION
  • CANINE HEART
  • ACTIVATION
  • GUIDELINES
  • VISUALIZATION
  • ELECTROGRAMS

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