Multi-modality imaging in cardiac resynchronization therapy: In silico and in vivo analyses

Heart failure (HF) is a serious condition that carries a high disease burden, affecting 1-2% of the adult population. In approximately 25% of HF patients, the underlying mechanism of HF is attributed to a disturbance in the electrical conduction system of the heart, resulting in asynchronous contractions of the left and right heart chambers, a condition also known as dyssynchrony. Cardiac resynchronization therapy (CRT) is a treatment that involves simultaneous pacing of the two ventricles to reduce dyssynchrony. CRT has been shown to be effective in reducing symptoms, morbidity, and improving survival, and has become an important guideline-recommended treatment. However, there is a broad range of patient outcomes with CRT, which has led to investigations into mechanisms that contribute to the variability in response. This thesis aims to enhance the efficacy of CRT by improving patient selection and optimizing device implantation. To achieve this, the thesis seeks to enhance the understanding of the electrocardiogram for more precise patient selection in CRT and to develop an image-guided strategy for better positioning of the left ventricular lead.