TY - JOUR
T1 - Response to cardiac resynchronization therapy is determined by intrinsic electrical substrate rather than by its modification
AU - Strik, Marc
AU - Ploux, Sylvain
AU - Huntjens, Peter R.
AU - Nguyen, Uyen Chau
AU - Frontera, Antionio
AU - Eschalier, Romain
AU - Dubois, Remi
AU - Ritter, Philippe
AU - Klotz, Nicholas
AU - Vernooy, Kevin
AU - Haissaguerre, Michel
AU - Crijns, Harry J. G. M.
AU - Prinzen, Frits W.
AU - Bordachar, Pierre
PY - 2018/11/1
Y1 - 2018/11/1
N2 - Background: Electrocardiographic mapping (ECM) expresses electrical substrate through magnitude and direction of the activation delay vector (ADV). We investigated to what extent the response to cardiac resynchronization therapy (CRT) is determined by baseline ADV and by ADV modification through CRT and optimization of left ventricular (LV) pacing site. Methods: ECM was performed in 79 heart failure patients (4 RBBB, 12 QRS <120 ms, 23 non-specific conduction delay [NICD] and 40 left bundle branch block [LBBB]). 67 patients (QRS >= 120 ms) underwent CRT implantation and in 26 patients multiple LV pacing site optimization was performed. ADV was calculated from locations/depolarization times of 2000 virtual epicardial electrodes derived from ECM. Acute response was defined as >= 10% LVdP/dt(max) increase, chronic response by composite clinical score at 6 months. Results: During intrinsic conduction, ADV direction was similar in patients with QRS < 120 ms, NICD and LBBB, pointing towards the LV free wall, while ADV magnitude was larger in LBBB (117 +/- 25 ms) than in NICD (70 +/- 29 ms, P < 0.05) and QRS < 120 ms (52 +/- 14 ms, P < 0.05). Intrinsic ADV accurately predicted the acute (AUC = 0.93) and chronic (AUC = 0.90) response to CRT. ADV change by CRT only moderately predicted response (highest AUC = 0.76). LV pacing site optimization had limited effects: +3 +/- 4% LVdP/dt(max) when compared to conventional basolateral LV pacing. Conclusion: The baseline electrical substrate, adequately measured by ADV amplitude, strongly determines acute and chronic CRT response, while the extent of its modification by conventional CRT or by varying LV pacing sites has limited effects. (c) 2018 Elsevier B.V. All rights reserved.
AB - Background: Electrocardiographic mapping (ECM) expresses electrical substrate through magnitude and direction of the activation delay vector (ADV). We investigated to what extent the response to cardiac resynchronization therapy (CRT) is determined by baseline ADV and by ADV modification through CRT and optimization of left ventricular (LV) pacing site. Methods: ECM was performed in 79 heart failure patients (4 RBBB, 12 QRS <120 ms, 23 non-specific conduction delay [NICD] and 40 left bundle branch block [LBBB]). 67 patients (QRS >= 120 ms) underwent CRT implantation and in 26 patients multiple LV pacing site optimization was performed. ADV was calculated from locations/depolarization times of 2000 virtual epicardial electrodes derived from ECM. Acute response was defined as >= 10% LVdP/dt(max) increase, chronic response by composite clinical score at 6 months. Results: During intrinsic conduction, ADV direction was similar in patients with QRS < 120 ms, NICD and LBBB, pointing towards the LV free wall, while ADV magnitude was larger in LBBB (117 +/- 25 ms) than in NICD (70 +/- 29 ms, P < 0.05) and QRS < 120 ms (52 +/- 14 ms, P < 0.05). Intrinsic ADV accurately predicted the acute (AUC = 0.93) and chronic (AUC = 0.90) response to CRT. ADV change by CRT only moderately predicted response (highest AUC = 0.76). LV pacing site optimization had limited effects: +3 +/- 4% LVdP/dt(max) when compared to conventional basolateral LV pacing. Conclusion: The baseline electrical substrate, adequately measured by ADV amplitude, strongly determines acute and chronic CRT response, while the extent of its modification by conventional CRT or by varying LV pacing sites has limited effects. (c) 2018 Elsevier B.V. All rights reserved.
KW - Left bundle branch block
KW - Cardiac resynchronization therapy
KW - Cardiac resynchronization
KW - Cardiac mapping
KW - Heart failure
KW - DYSSYNCHRONOUS CANINE HEART
KW - VENTRICULAR PACING SITES
KW - PATIENT SELECTION
KW - FAILURE PATIENTS
KW - TRIAL
KW - NONRESPONDERS
KW - IMPROVEMENT
KW - CONDUCTION
U2 - 10.1016/j.ijcard.2018.06.005
DO - 10.1016/j.ijcard.2018.06.005
M3 - Article
C2 - 29895424
SN - 0167-5273
VL - 270
SP - 143
EP - 148
JO - International Journal of Cardiology
JF - International Journal of Cardiology
ER -