Electrocardiogram Belt Guidance for Left Ventricular Lead Placement and Biventricular Pacing Optimization

John Rickard; Kevin Jackson; Michael Gold; Mauro Biffi; Matteo Ziacchi; Joshua Silverstein; Brian Ramza; Mark Metzl; Eric Grubman; Richard Abben; Niraj Varma; Ghiyath Tabbal; Cory Jensen; Griet Wouters; Subham Ghosh; Kevin Vernooy; ECG Belt for CRT Response Study Group

doi:10.1016/j.hrthm.2022.11.015

Electrocardiogram Belt Guidance for Left Ventricular Lead Placement and Biventricular Pacing Optimization

John Rickard^*, Kevin Jackson, Michael Gold, Mauro Biffi, Matteo Ziacchi, Joshua Silverstein, Brian Ramza, Mark Metzl, Eric Grubman, Richard Abben, Niraj Varma, Ghiyath Tabbal, Cory Jensen, Griet Wouters, Subham Ghosh, Kevin Vernooy, ECG Belt for CRT Response Study Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Patients with ischemic cardiomyopathy, non-left bundle branch block (LBBB), or QRS duration <150msec have a lower response rate to CRT than other indicated patients. The EBS is a novel surface mapping system designed to measure electrical dyssynchrony via the standard deviation of the activation times (SDAT) of the left ventricle.

OBJECTIVE: To evaluate the efficacy of the ECG Belt System (EBS) in patients less likely to respond to cardiac resynchronization therapy (CRT) and determine whether EBS use in lead placement guidance and device programming was superior compared with standard CRT care.

METHODS: This was a prospective, randomized trial of heart failure patients with EBS-guided CRT implant and programming vs. standard CRT care. The primary endpoint was relative change in LV end-systolic volume from baseline to 6 months post-implant.

RESULTS: A total of 408 subjects from centers in Europe and North America were randomized. Although both EBS and control patients had a mean improvement in LVESV, there was no significant difference in relative change from baseline (p=0.26). While patients with a higher baseline SDAT derived greater LV reverse remodeling, improvement in electrical dyssynchrony did not correlate with the extent of reverse remodeling.

CONCLUSION: The findings of the present study do not support EBS-guided therapy for CRT management of heart failure with reduced ejection fraction.

Original language	English
Journal	Heart Rhythm
DOIs	https://doi.org/10.1016/j.hrthm.2022.11.015
Publication status	E-pub ahead of print - 25 Nov 2022

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10.1016/j.hrthm.2022.11.015

Cite this

Rickard, J., Jackson, K., Gold, M., Biffi, M., Ziacchi, M., Silverstein, J., Ramza, B., Metzl, M., Grubman, E., Abben, R., Varma, N., Tabbal, G., Jensen, C., Wouters, G., Ghosh, S., Vernooy, K., & ECG Belt for CRT Response Study Group (2022). Electrocardiogram Belt Guidance for Left Ventricular Lead Placement and Biventricular Pacing Optimization. Heart Rhythm. https://doi.org/10.1016/j.hrthm.2022.11.015

@article{382cfd7aed8d49d0a1d8f40d12bb339f,

title = "Electrocardiogram Belt Guidance for Left Ventricular Lead Placement and Biventricular Pacing Optimization",

abstract = "BACKGROUND: Patients with ischemic cardiomyopathy, non-left bundle branch block (LBBB), or QRS duration <150msec have a lower response rate to CRT than other indicated patients. The EBS is a novel surface mapping system designed to measure electrical dyssynchrony via the standard deviation of the activation times (SDAT) of the left ventricle.OBJECTIVE: To evaluate the efficacy of the ECG Belt System (EBS) in patients less likely to respond to cardiac resynchronization therapy (CRT) and determine whether EBS use in lead placement guidance and device programming was superior compared with standard CRT care.METHODS: This was a prospective, randomized trial of heart failure patients with EBS-guided CRT implant and programming vs. standard CRT care. The primary endpoint was relative change in LV end-systolic volume from baseline to 6 months post-implant.RESULTS: A total of 408 subjects from centers in Europe and North America were randomized. Although both EBS and control patients had a mean improvement in LVESV, there was no significant difference in relative change from baseline (p=0.26). While patients with a higher baseline SDAT derived greater LV reverse remodeling, improvement in electrical dyssynchrony did not correlate with the extent of reverse remodeling.CONCLUSION: The findings of the present study do not support EBS-guided therapy for CRT management of heart failure with reduced ejection fraction.",

author = "John Rickard and Kevin Jackson and Michael Gold and Mauro Biffi and Matteo Ziacchi and Joshua Silverstein and Brian Ramza and Mark Metzl and Eric Grubman and Richard Abben and Niraj Varma and Ghiyath Tabbal and Cory Jensen and Griet Wouters and Subham Ghosh and Kevin Vernooy and {ECG Belt for CRT Response Study Group}",

note = "Copyright {\textcopyright} 2022. Published by Elsevier Inc.",

year = "2022",

month = nov,

day = "25",

doi = "10.1016/j.hrthm.2022.11.015",

language = "English",

journal = "Heart Rhythm",

issn = "1547-5271",

publisher = "Elsevier Science",

}

Rickard, J, Jackson, K, Gold, M, Biffi, M, Ziacchi, M, Silverstein, J, Ramza, B, Metzl, M, Grubman, E, Abben, R, Varma, N, Tabbal, G, Jensen, C, Wouters, G, Ghosh, S, Vernooy, K & ECG Belt for CRT Response Study Group 2022, 'Electrocardiogram Belt Guidance for Left Ventricular Lead Placement and Biventricular Pacing Optimization', Heart Rhythm. https://doi.org/10.1016/j.hrthm.2022.11.015

TY - JOUR

T1 - Electrocardiogram Belt Guidance for Left Ventricular Lead Placement and Biventricular Pacing Optimization

AU - Rickard, John

AU - Jackson, Kevin

AU - Gold, Michael

AU - Biffi, Mauro

AU - Ziacchi, Matteo

AU - Silverstein, Joshua

AU - Ramza, Brian

AU - Metzl, Mark

AU - Grubman, Eric

AU - Abben, Richard

AU - Varma, Niraj

AU - Tabbal, Ghiyath

AU - Jensen, Cory

AU - Wouters, Griet

AU - Ghosh, Subham

AU - Vernooy, Kevin

AU - ECG Belt for CRT Response Study Group

PY - 2022/11/25

Y1 - 2022/11/25

N2 - BACKGROUND: Patients with ischemic cardiomyopathy, non-left bundle branch block (LBBB), or QRS duration <150msec have a lower response rate to CRT than other indicated patients. The EBS is a novel surface mapping system designed to measure electrical dyssynchrony via the standard deviation of the activation times (SDAT) of the left ventricle.OBJECTIVE: To evaluate the efficacy of the ECG Belt System (EBS) in patients less likely to respond to cardiac resynchronization therapy (CRT) and determine whether EBS use in lead placement guidance and device programming was superior compared with standard CRT care.METHODS: This was a prospective, randomized trial of heart failure patients with EBS-guided CRT implant and programming vs. standard CRT care. The primary endpoint was relative change in LV end-systolic volume from baseline to 6 months post-implant.RESULTS: A total of 408 subjects from centers in Europe and North America were randomized. Although both EBS and control patients had a mean improvement in LVESV, there was no significant difference in relative change from baseline (p=0.26). While patients with a higher baseline SDAT derived greater LV reverse remodeling, improvement in electrical dyssynchrony did not correlate with the extent of reverse remodeling.CONCLUSION: The findings of the present study do not support EBS-guided therapy for CRT management of heart failure with reduced ejection fraction.

AB - BACKGROUND: Patients with ischemic cardiomyopathy, non-left bundle branch block (LBBB), or QRS duration <150msec have a lower response rate to CRT than other indicated patients. The EBS is a novel surface mapping system designed to measure electrical dyssynchrony via the standard deviation of the activation times (SDAT) of the left ventricle.OBJECTIVE: To evaluate the efficacy of the ECG Belt System (EBS) in patients less likely to respond to cardiac resynchronization therapy (CRT) and determine whether EBS use in lead placement guidance and device programming was superior compared with standard CRT care.METHODS: This was a prospective, randomized trial of heart failure patients with EBS-guided CRT implant and programming vs. standard CRT care. The primary endpoint was relative change in LV end-systolic volume from baseline to 6 months post-implant.RESULTS: A total of 408 subjects from centers in Europe and North America were randomized. Although both EBS and control patients had a mean improvement in LVESV, there was no significant difference in relative change from baseline (p=0.26). While patients with a higher baseline SDAT derived greater LV reverse remodeling, improvement in electrical dyssynchrony did not correlate with the extent of reverse remodeling.CONCLUSION: The findings of the present study do not support EBS-guided therapy for CRT management of heart failure with reduced ejection fraction.

U2 - 10.1016/j.hrthm.2022.11.015

DO - 10.1016/j.hrthm.2022.11.015

M3 - Article

C2 - 36442824

SN - 1547-5271

JO - Heart Rhythm

JF - Heart Rhythm

ER -