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 journalArticleAcademicpeer-review


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 languageEnglish
JournalHeart Rhythm
Publication statusE-pub ahead of print - 25 Nov 2022

Cite this