TY - JOUR
T1 - Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response: site of latest left ventricular activation relative to pacing site
AU - Parreira, L.
AU - Tsyganov, A.
AU - Artyukhina, E.
AU - Vernooy, K.
AU - Tondo, C.
AU - Adragao, P.
AU - Ascione, C.
AU - Carmo, P.
AU - Carvalho, S.
AU - Egger, M.
AU - Ferreira, A.
AU - Ghossein, M.
AU - Holm, M.
AU - Kalinin, V.
AU - Malakhova, M.
AU - Meine, M.
AU - Nunes, S.
AU - Podolyak, D.
AU - Revishvili, A.
AU - Shapieva, A.
AU - Stepanova, V.
AU - van Stipdonk, A.
AU - Taymasova, I.
AU - Wouters, P.
AU - Zubarev, S.
AU - Leyva, F.
AU - Auricchio, A.
AU - Varma, N.
N1 - 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.
PY - 2023/4/1
Y1 - 2023/4/1
N2 - 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 Consecutive CRT patients underwent ECGI and chest/heart computed tomography 6-24 months of post-implant. Latest and results electrically activated site and the distance to LVPS (d
p) 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 d
p. 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. d
p was 42 ± 23 mm [31 ± 14 mm for responders vs. 63 ± 24 mm non-responders (P < 0.001)]. Longer d
p and the lack of use of CRT optimization algorithm were the only independent predictors of non-response [area under the curve (AUC) 0.906]. d
p 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. Noninvasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.
AB - 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 Consecutive CRT patients underwent ECGI and chest/heart computed tomography 6-24 months of post-implant. Latest and results electrically activated site and the distance to LVPS (d
p) 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 d
p. 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. d
p was 42 ± 23 mm [31 ± 14 mm for responders vs. 63 ± 24 mm non-responders (P < 0.001)]. Longer d
p and the lack of use of CRT optimization algorithm were the only independent predictors of non-response [area under the curve (AUC) 0.906]. d
p 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. Noninvasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.
KW - Cardiac resynchronization therapy
KW - Heart failure
KW - Non-invasive 3D electrical activation mapping
KW - Electrocardiographic imaging
KW - ECGI
KW - Ischaemic cardiomyopathy
KW - Dilated cardiomyopathy
KW - HEART-FAILURE
KW - PATIENT
KW - LEAD
KW - ECHOCARDIOGRAPHY
KW - PLACEMENT
U2 - 10.1093/europace/euad041
DO - 10.1093/europace/euad041
M3 - Article
C2 - 36857597
SN - 1099-5129
VL - 25
SP - 1458
EP - 1466
JO - EP Europace
JF - EP Europace
IS - 4
ER -