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Sedova KA, van Dam PM, Blahova M, Necasova L, Kautzner J. Localization of the ventricular pacing site from BSPM and standard 12-lead ECG: a comparison study. Sci Rep 2023; 13:9618. [PMID: 37316547 DOI: 10.1038/s41598-023-36768-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 06/09/2023] [Indexed: 06/16/2023] Open
Abstract
Inverse ECG imaging methods typically require 32-250 leads to create body surface potential maps (BSPM), limiting their routine clinical use. This study evaluated the accuracy of PaceView inverse ECG method to localize the left or right ventricular (LV and RV, respectively) pacing leads using either a 99-lead BSPM or the 12-lead ECG. A 99-lead BSPM was recorded in patients with cardiac resynchronization therapy (CRT) during sinus rhythm and sequential LV/RV pacing. The non-contrast CT was performed to localize precisely both ECG electrodes and CRT leads. From a BSPM, nine signals were selected to obtain the 12-lead ECG. Both BSPM and 12-lead ECG were used to localize the RV and LV lead, and the localization error was calculated. Consecutive patients with dilated cardiomyopathy, previously implanted with a CRT device, were enrolled (n = 19). The localization error for the RV/LV lead was 9.0 [IQR 4.8-13.6] / 7.7 [IQR 0.0-10.3] mm using the 12-lead ECG and 9.1 [IQR 5.4-15.7] / 9.8 [IQR 8.6-13.1] mm for the BSPM. Thus, the noninvasive lead localization using the 12-lead ECG was accurate enough and comparable to 99-lead BSPM, potentially increasing the capability of 12-lead ECG for the optimization of the LV/RV pacing sites during CRT implant or for the most favorable programming.
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Affiliation(s)
- Ksenia A Sedova
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Sitna Sq. 3105, 27201, Kladno, Czech Republic.
| | - Peter M van Dam
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marie Blahova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Lucie Necasova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Sedova KA, van Dam PM, Sbrollini A, Burattini L, Necasova L, Blahova M, Bocek J, Sramko M, Kautzner J. Assessment of electrical dyssynchrony in cardiac resynchronization therapy: 12-lead electrocardiogram vs. 96-lead body surface map. Europace 2023; 25:554-560. [PMID: 36107025 PMCID: PMC10103567 DOI: 10.1093/europace/euac159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS The standard deviation of activation time (SDAT) derived from body surface maps (BSMs) has been proposed as an optimal measure of electrical dyssynchrony in patients with cardiac resynchronization therapy (CRT). The goal of this study was two-fold: (i) to compare the values of SDAT in individual CRT patients with reconstructed myocardial metrics of depolarization heterogeneity using an inverse solution algorithm and (ii) to compare SDAT calculated from 96-lead BSM with a clinically easily applicable 12-lead electrocardiogram (ECG). METHODS AND RESULTS Cardiac resynchronization therapy patients with sinus rhythm and left bundle branch block at baseline (n = 19, 58% males, age 60 ± 11 years, New York Heart Association Classes II and III, QRS 167 ± 16) were studied using a 96-lead BSM. The activation time (AT) was automatically detected for each ECG lead, and SDAT was calculated using either 96 leads or standard 12 leads. Standard deviation of activation time was assessed in sinus rhythm and during six different pacing modes, including atrial pacing, sequential left or right ventricular, and biventricular pacing. Changes in SDAT calculated both from BSM and from 12-lead ECG corresponded to changes in reconstructed myocardial ATs. A high degree of reliability was found between SDAT values obtained from 12-lead ECG and BSM for different pacing modes, and the intraclass correlation coefficient varied between 0.78 and 0.96 (P < 0.001). CONCLUSION Standard deviation of activation time measurement from BSM correlated with reconstructed myocardial ATs, supporting its utility in the assessment of electrical dyssynchrony in CRT. Importantly, 12-lead ECG provided similar information as BSM. Further prospective studies are necessary to verify the clinical utility of SDAT from 12-lead ECG in larger patient cohorts, including those with ischaemic cardiomyopathy.
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Affiliation(s)
- Ksenia A Sedova
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Sitna Sq. 3105, 27201 Kladno, Czech Republic
| | - Peter M van Dam
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Agnese Sbrollini
- Department of Information Engineering, Università Politecnica delle Marche, via Brecce Bianche 12, 60131 Ancona, Italy
| | - Laura Burattini
- Department of Information Engineering, Università Politecnica delle Marche, via Brecce Bianche 12, 60131 Ancona, Italy
| | - Lucie Necasova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic
| | - Marie Blahova
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic
| | - Jan Bocek
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic
| | - Marek Sramko
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeňská 1958/9, 140 21 Prague 4, Czech Republic
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Bilchick KC, Morgounova E, Oomen P, Malhotra R, Mason PK, Mangrum M, Kim D, Gao X, Darby AE, Monfredi OJ, Aso JA, Franzen PM, Stadler RW. First-in-human noninvasive left ventricular ultrasound pacing: A potential screening tool for cardiac resynchronization therapy. Heart Rhythm O2 2023; 4:79-87. [PMID: 36873311 PMCID: PMC9975015 DOI: 10.1016/j.hroo.2022.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background A screening tool to predict response to cardiac resynchronization therapy (CRT) could improve patient selection and outcomes. Objective The purpose of this study was to investigate the feasibility and safety of noninvasive CRT via transcutaneous ultrasonic left ventricular (LV) pacing applied as a screening test before CRT implants. Methods P-wave-triggered ultrasound stimuli were delivered during bolus dosing of an echocardiographic contrast agent to simulate CRT noninvasively. Ultrasound pacing was delivered at a variety of LV locations with a range of atrioventricular delays to achieve fusion with intrinsic ventricular activation. Three-dimensional cardiac activation maps were acquired via the Medtronic CardioInsight 252-electrode mapping vest during baseline, ultrasound pacing, and after CRT implantation. A separate control group received only the CRT implants. Results Ultrasound pacing was achieved in 10 patients with a mean of 81.2 ± 50.8 ultrasound paced beats per patient and up to 20 consecutive beats of ultrasound pacing. QRS width at baseline (168.2 ± 17.8 ms) decreased significantly to 117.3 ± 21.5 ms (P <.001) in the best ultrasound paced beat and to 125.8 ± 13.3 ms (P <.001) in the best CRT beat. Electrical activation patterns were similar between CRT pacing and ultrasound pacing with stimulation from the same area of the LV. Troponin results were similar between the ultrasound pacing and the control groups (P = .96), confirming safety. Conclusion Noninvasive ultrasound pacing before CRT is safe and feasible, and it estimates the degree of electrical resynchronization achievable with CRT. Further study of this promising technique to guide CRT patient selection is warranted.
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Affiliation(s)
| | | | - Pim Oomen
- University of California Irvine, Irvine, California
| | - Rohit Malhotra
- University of Virginia Health System, Charlottesville, Virginia
| | - Pamela K Mason
- University of Virginia Health System, Charlottesville, Virginia
| | - Mike Mangrum
- University of Virginia Health System, Charlottesville, Virginia
| | - David Kim
- University of Virginia Health System, Charlottesville, Virginia
| | - Xu Gao
- Northwestern Medicine, Chicago, Illinois
| | - Andrew E Darby
- University of Virginia Health System, Charlottesville, Virginia
| | | | - Joy A Aso
- Medtronic plc, Mounds View, Minnesota
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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. Electrocardiogram Belt guidance for left ventricular lead placement and biventricular pacing optimization. Heart Rhythm 2022; 20:537-544. [PMID: 36442824 DOI: 10.1016/j.hrthm.2022.11.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients with ischemic cardiomyopathy, non-left bundle branch block, or QRS duration <150 ms have a lower response rate to cardiac resynchronization therapy (CRT) than did other indicated patients. The ECG Belt system (EBS) is a novel surface mapping system designed to measure electrical dyssynchrony via the standard deviation of the activation times of the left ventricle. OBJECTIVES The objectives of this study were to evaluate the efficacy of the EBS in patients less likely to respond to CRT and to determine whether EBS use in lead placement guidance and device programming was superior to standard CRT care. METHODS This was a prospective randomized trial of patients with heart failure and EBS-guided CRT implantation and programming vs standard CRT care. The primary end point was relative change in left ventricular end-systolic volume from baseline to 6 months postimplantation. RESULTS A total of 408 patients from centers in Europe and North America were randomized. Although both patients with EBS and control patients had a mean improvement in left ventricular end-systolic volume, there was no significant difference in relative change from baseline (P = .26). While patients with a higher baseline standard deviation of the activation times derived greater left ventricular 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.
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Affiliation(s)
- John Rickard
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Kevin Jackson
- Section of Cardiac Electrophysiology, Division of Cardiovascular Disease, Duke University Medical Center, Durham, North Carolina
| | - Michael Gold
- Department of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mauro Biffi
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Matteo Ziacchi
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Cardiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Brian Ramza
- Division of Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Mark Metzl
- Department of Medicine, NorthShore University HealthSystem, Evanston, Illinois
| | - Eric Grubman
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Richard Abben
- Cardiac Interventions and Cardiac Arrythmia Center, Cardiovascular Institute of the South, Houma, Louisiana
| | - Niraj Varma
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ghiyath Tabbal
- Cardiac Interventions and Cardiac Arrythmia Center, Cardiovascular Institute of the South, Houma, Louisiana
| | - Cory Jensen
- Department of Cardiac Electrophysiology, Heartland Cardiology, Wichita, Kansas
| | - Griet Wouters
- Department of Cardiac Rhythm Management, Medtronic Inc., Mounds View, Minnesota
| | - Subham Ghosh
- Department of Cardiac Rhythm Management, Medtronic Inc., Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
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Vijayaraman P, Hughes G, Manganiello M, Johns A, Ghosh S. Non-invasive assessment of ventricular electrical heterogeneity to optimize left bundle branch area pacing. J Interv Card Electrophysiol 2022:10.1007/s10840-022-01315-9. [PMID: 35907107 DOI: 10.1007/s10840-022-01315-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Left bundle branch area pacing (LBBAP) is a novel therapeutic option for bradycardia and heart failure patients. ECG belt is a novel technology for assessment of ventricular electrical heterogeneity (VEH) using multi-electrode ECG. A metric of overall VEH based on standard deviation of activation times (SDAT) from all electrodes in the ECG belt has been previously shown to predict cardiac resynchronization therapy (CRT) response. The aim of the study is to evaluate non-invasive assessment of VEH using ECG belt to optimize LBBAP. METHODS VEH from a 40-electrode ECG belt was characterized in 20 patients (male 15, EF 33 ± 13%, NYHA class 3.05 ± 0.6; CRT indication 18) during LBBAP (20) and LBBAP-Optimized CRT (LOT-CRT-7), anodal capture (16), NS-LBBP (18), S-LBBP (5), LVSP (9). In addition to SDAT, regional (LV/RV) VEH was assessed with average left ventricular activation times (LVAT), SDAT of left-sided (LV dispersion) and right-sided (RV dispersion) electrodes. Optimal LBBAP was determined based on maximal SDAT and QRS duration (d) change. RESULTS All metrics were significantly reduced (p < 0.0001 for ECG belt metrics, p = 0.0027 for QRSd) during LBBAP and LOT-CRT compared to intrinsic. QRSd, SDAT, LVAT, and LV and RV dispersion during optimal LBBAP were significantly lower (133 ± 20/157 ± 24; 20.5 ± 7.5/38.6 ± 9; 44.4 ± 14.3/61.4 ± 21; 11.6 ± 11.6/29.5 ± 15; 21.1 ± 7.8/42.5 ± 9.3; p < 0.0001) compared to intrinsic rhythm. However, they were not significantly different among selective, non-selective, anodal, and LV septal captures. EF and NYHA class improved to 46 ± 11% and 1.9 ± 0.6 (p < 0.001). CONCLUSIONS LBBAP significantly reduced overall and regional (RV/LV) VEH, irrespective of the mechanism of capture. Detailed assessment of electrical heterogeneity using ECG belt may add valuable insights on effects of LBBAP. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04583709.
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Affiliation(s)
- Pugazhendhi Vijayaraman
- Cardiac Electrophysiology, Geisinger Heart Institute, Geisinger Commonwealth School of Medicine, MC 36-10, 1000 E Mountain Blvd, Wilkes Barre, PA, 18711, USA.
| | - Grace Hughes
- Clinical Trials Unit, Geisinger Health System, Wilkes Barre, PA, USA
| | | | - Alicia Johns
- Department of Population Health Sciences, Geisinger Health System, Danville, PA, USA
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Mizner J, Jurak P, Linkova H, Smisek R, Curila K. Ventricular Dyssynchrony and Pacing-induced Cardiomyopathy in Patients with Pacemakers, the Utility of Ultra-high-frequency ECG and Other Dyssynchrony Assessment Tools. Arrhythm Electrophysiol Rev 2022; 11:e17. [PMID: 35990106 PMCID: PMC9376832 DOI: 10.15420/aer.2022.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 04/09/2022] [Indexed: 11/23/2022] Open
Abstract
The majority of patients tolerate right ventricular pacing well; however, some patients manifest signs of heart failure after pacemaker implantation and develop pacing-induced cardiomyopathy. This is a consequence of non-physiological ventricular activation bypassing the conduction system. Ventricular dyssynchrony was identified as one of the main factors responsible for pacing-induced cardiomyopathy development. Currently, methods that would allow rapid and reliable ventricular dyssynchrony assessment, ideally during the implant procedure, are lacking. Paced QRS duration is an imperfect marker of dyssynchrony, and methods based on body surface mapping, electrocardiographic imaging or echocardiography are laborious and time-consuming, and can be difficult to use during the implantation procedure. However, the ventricular activation sequence can be readily displayed from the chest leads using an ultra-high-frequency ECG. It can be performed during the implantation procedure to visualise ventricular depolarisation and resultant ventricular dyssynchrony during pacing. This information can assist the electrophysiologist in selecting a pacing location that avoids dyssynchronous ventricular activation.
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Affiliation(s)
- Jan Mizner
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pavel Jurak
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Hana Linkova
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Radovan Smisek
- Institute of Scientific Instruments of the Czech Academy of Sciences, Brno, Czech Republic
| | - Karol Curila
- Department of Cardiology, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Strik M, Ploux S, Bordachar P. What Body Surface Mapping Has Taught Us About Ventricular Conduction Disease Implications for Cardiac Resynchronization Therapy and His Bundle Pacing. Card Electrophysiol Clin 2022; 14:213-221. [PMID: 35715079 DOI: 10.1016/j.ccep.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The degree and pattern of conduction disease seem determinant when assessing potential cardiac resynchronization therapy (CRT) candidates. In the present review, the authors discuss the available noninvasive techniques that can be used to acquire ventricular activation time maps. They describe what body surface mapping has taught us about left bundle branch block, right bundle branch block, intraventricular conduction delay, and right ventricular pacing and discuss the ability of derived parameters of electrical dyssynchrony to predict long-term clinical response to CRT or His bundle pacing.
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Affiliation(s)
- Marc Strik
- Bordeaux University Hospital (CHU), Avenue de Magellan, Pessac F-33600, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Av. du Haut Lévêque, 33600 Pessac, France.
| | - Sylvain Ploux
- Bordeaux University Hospital (CHU), Avenue de Magellan, Pessac F-33600, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Av. du Haut Lévêque, 33600 Pessac, France
| | - Pierre Bordachar
- Bordeaux University Hospital (CHU), Avenue de Magellan, Pessac F-33600, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Av. du Haut Lévêque, 33600 Pessac, France
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Elliott MK, Blauer J, Mehta VS, Sidhu BS, Gould J, Jackson T, Sieniewicz B, Niederer S, Ghosh S, Rinaldi CA. Comparison of electrical dyssynchrony parameters between electrocardiographic imaging and a simulated ECG belt. J Electrocardiol 2021; 68:117-123. [PMID: 34416669 DOI: 10.1016/j.jelectrocard.2021.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/22/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
AIMS Electrocardiographic imaging (ECGi) and the ECG belt are body surface potential mapping systems which can assess electrical dyssynchrony in patients undergoing cardiac resynchronization therapy (CRT). ECGi-derived dyssynchrony metrics are calculated from reconstructed epicardial potentials based on body surface potentials combined with a thoracic CT scan, while the ECG belt relies on body surface potentials alone. The relationship between dyssynchrony metrics from these two systems is unknown. In this study we aim to compare intra-ventricular and inter-ventricular dyssynchrony metrics between ECGi and the ECG belt. METHODS Seventeen patients underwent ECGi after CRT. A subsample of 40 body surface potentials was used to simulate the ECG belt. ECGi dyssynchrony metrics, calculated from reconstructed epicardial potentials, and ECG belt dyssynchrony metrics, calculated from the sampled body surface potentials were compared. RESULTS There was a strong positive correlation between ECGi left ventricular activation time (LVAT) and ECG belt left thorax activation time (LTAT) (R = 0.88 ; P < 0.001) and between ECGi standard deviation of activation times (SDAT) and ECG belt-SDAT (R = 0.76; P < 0.001) during intrinsic rhythm. The correlation for both pairs was also strong during biventricular pacing. Ventricular electrical uncoupling, a well validated ECGi inter-ventricular dyssynchrony metric, correlated strongly with ECG belt-SDAT during intrinsic rhythm (R = 0.76; P < 0.001) but not biventricular pacing (R = 0.29; P = 0.26). Cranial or caudal displacement of the simulated ECG belt did not affect LTAT or SDAT. CONCLUSION ECGi- and ECG belt-derived intra-ventricular and inter-ventricular dyssynchrony metrics were strongly correlated. The ECG belt may offer comparable dyssynchrony assessment to ECGi, with associated practical and cost advantages.
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Affiliation(s)
- Mark K Elliott
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | | | - Vishal S Mehta
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Baldeep S Sidhu
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Justin Gould
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Tom Jackson
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Benjamin Sieniewicz
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Steven Niederer
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
| | | | - Christopher A Rinaldi
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK; Department of Cardiology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Sedova K, Repin K, Donin G, Dam PV, Kautzner J. Clinical Utility of Body Surface Potential Mapping in CRT Patients. Arrhythm Electrophysiol Rev 2021; 10:113-119. [PMID: 34401184 PMCID: PMC8335851 DOI: 10.15420/aer.2021.14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 05/12/2021] [Indexed: 12/15/2022] Open
Abstract
This paper reviews the current status of the knowledge on body surface potential mapping (BSPM) and ECG imaging (ECGI) methods for patient selection, left ventricular (LV) lead positioning, and optimisation of CRT programming, to indicate the major trends and future perspectives for the application of these methods in CRT patients. A systematic literature review using PubMed, Scopus, and Web of Science was conducted to evaluate the available clinical evidence regarding the usage of BSPM and ECGI methods in CRT patients. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement was used as a basis for this review. BSPM and ECGI methods applied in CRT patients were assessed, and quantitative parameters of ventricular depolarisation delivered from BSPM and ECGI were extracted and summarised. BSPM and ECGI methods can be used in CRT in several ways, namely in predicting CRT outcome, in individualised optimisation of CRT device programming, and the guiding of LV electrode placement, however, further prospective or randomised trials are necessary to verify the utility of BSPM for routine clinical practice.
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Affiliation(s)
- Ksenia Sedova
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Kirill Repin
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Gleb Donin
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czech Republic
| | - Peter Van Dam
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
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Haq KT, Rogovoy NM, Thomas JA, Hamilton C, Lutz KJ, Wirth A, Bender AB, German DM, Przybylowicz R, van Dam P, Dewland TA, Dalouk K, Stecker E, Nazer B, Jessel PM, MacMurdy KS, Zarraga IGE, Beitinjaneh B, Henrikson CA, Raitt M, Fuss C, Ferencik M, Tereshchenko LG. Adaptive Cardiac Resynchronization Therapy Effect on Electrical Dyssynchrony (aCRT-ELSYNC): A randomized controlled trial. Heart Rhythm O2 2021; 2:374-381. [PMID: 34430943 PMCID: PMC8369305 DOI: 10.1016/j.hroo.2021.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Adaptive cardiac resynchronization therapy (aCRT) is known to have clinical benefits over conventional CRT, but the mechanisms are unclear. OBJECTIVE Compare effects of aCRT and conventional CRT on electrical dyssynchrony. METHODS A prospective, double-blind, 1:1 parallel-group assignment randomized controlled trial in patients receiving CRT for routine clinical indications. Participants underwent cardiac computed tomography and 128-electrode body surface mapping. The primary outcome was change in electrical dyssynchrony measured on the epicardial surface using noninvasive electrocardiographic imaging before and 6 months post-CRT. Ventricular electrical uncoupling (VEU) was calculated as the difference between the mean left ventricular (LV) and right ventricular (RV) activation times. An electrical dyssynchrony index (EDI) was computed as the standard deviation of local epicardial activation times. RESULTS We randomized 27 participants (aged 64 ± 12 years; 34% female; 53% ischemic cardiomyopathy; LV ejection fraction 28% ± 8%; QRS duration 155 ± 21 ms; typical left bundle branch block [LBBB] in 13%) to conventional CRT (n = 15) vs aCRT (n = 12). In atypical LBBB (n = 11; 41%) with S waves in V5-V6, conduction block occurred in the anterior RV, as opposed to the interventricular groove in strict LBBB. As compared to baseline, VEU reduced post-CRT in the aCRT (median reduction 18.9 [interquartile range 4.3-29.2 ms; P = .034]), but not in the conventional CRT (21.4 [-30.0 to 49.9 ms; P = .525]) group. There were no differences in the degree of change in VEU and EDI indices between treatment groups. CONCLUSION The effect of aCRT and conventional CRT on electrical dyssynchrony is largely similar, but only aCRT harmoniously reduced interventricular dyssynchrony by reducing RV uncoupling.
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Affiliation(s)
- Kazi T. Haq
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Nichole M. Rogovoy
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Jason A. Thomas
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- University of Washington, Seattle, Washington
| | - Christopher Hamilton
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Katherine J. Lutz
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Ashley Wirth
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Aron B. Bender
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- University of California Los Angeles, Los Angeles, California
| | - David M. German
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Ryle Przybylowicz
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | | | - Thomas A. Dewland
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- University of California San Francisco, San Francisco, California
| | - Khidir Dalouk
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Eric Stecker
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Babak Nazer
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Peter M. Jessel
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Karen S. MacMurdy
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Ignatius Gerardo E. Zarraga
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Bassel Beitinjaneh
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Charles A. Henrikson
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
| | - Merritt Raitt
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
| | - Cristina Fuss
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, Oregon
| | - Maros Ferencik
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon
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11
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Arnold AD, Shun‐Shin MJ, Keene D, Howard JP, Chow J, Lim E, Lampridou S, Miyazawa AA, Muthumala A, Tanner M, Qureshi NA, Lefroy DC, Koa‐Wing M, Linton NWF, Boon Lim P, Peters NS, Kanagaratnam P, Auricchio A, Francis DP, Whinnett ZI. Electrocardiographic predictors of successful resynchronization of left bundle branch block by His bundle pacing. J Cardiovasc Electrophysiol 2021; 32:428-438. [PMID: 33345379 PMCID: PMC8607473 DOI: 10.1111/jce.14845] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/26/2020] [Accepted: 12/06/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND His bundle pacing (HBP) is an alternative to biventricular pacing (BVP) for delivering cardiac resynchronization therapy (CRT) in patients with heart failure and left bundle branch block (LBBB). It is not known whether ventricular activation times and patterns achieved by HBP are equivalent to intact conduction systems and not all patients with LBBB are resynchronized by HBP. OBJECTIVE To compare activation times and patterns of His-CRT with BVP-CRT, LBBB and intact conduction systems. METHODS In patients with LBBB, noninvasive epicardial mapping (ECG imaging) was performed during BVP and temporary HBP. Intrinsic activation was mapped in all subjects. Left ventricular activation times (LVAT) were measured and epicardial propagation mapping (EPM) was performed, to visualize epicardial wavefronts. Normal activation pattern and a normal LVAT range were determined from normal subjects. RESULTS Forty-five patients were included, 24 with LBBB and LV impairment, and 21 with normal 12-lead ECG and LV function. In 87.5% of patients with LBBB, His-CRT successfully shortened LVAT by ≥10 ms. In 33.3%, His-CRT resulted in complete ventricular resynchronization, with activation times and patterns indistinguishable from normal subjects. EPM identified propagation discontinuity artifacts in 83% of patients with LBBB. This was the best predictor of whether successful resynchronization was achieved by HBP (logarithmic odds ratio, 2.19; 95% confidence interval, 0.07-4.31; p = .04). CONCLUSION Noninvasive electrocardiographic mapping appears to identify patients whose LBBB can be resynchronized by HBP. In contrast to BVP, His-CRT may deliver the maximum potential ventricular resynchronization, returning activation times, and patterns to those seen in normal hearts.
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Affiliation(s)
- Ahran D. Arnold
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Matthew J. Shun‐Shin
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | | | - James P. Howard
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Ji‐Jian Chow
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Elaine Lim
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Smaragda Lampridou
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Alejandra A. Miyazawa
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Amal Muthumala
- Cardiology DepartmentNorth Middlesex University Hospital NHS TrustLondonUK
- Cardiology DepartmentSt. Bartholomew's Hospital, Barts Health NHS TrustLondonUK
| | - Mark Tanner
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Norman A. Qureshi
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - David C. Lefroy
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Michael Koa‐Wing
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Nick W. F. Linton
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Phang Boon Lim
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Nicholas S. Peters
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Prapa Kanagaratnam
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Angelo Auricchio
- Division of CardiologyFondazione Cardiocentro TicinoLuganoSwitzerland
| | - Darrel P. Francis
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
| | - Zachary I. Whinnett
- National Heart and Lung InstituteImperial College London, Hammersmith HospitalLondonUK
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12
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Rickard J, Jackson K, Biffi M, Vernooy K, Bank A, Cerkvenik J, Ghosh S, Gold MR. The ECG Belt for CRT response trial: Design and clinical protocol. Pacing Clin Electrophysiol 2020; 43:1063-1071. [PMID: 32537740 DOI: 10.1111/pace.13985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 04/17/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022]
Abstract
The ECG Belt for CRT response trial is designed to test the hypothesis that in patients traditionally less likely to respond to cardiac resynchronization therapy (CRT), an individualized approach utilizing the electrocardiogram (ECG) Belt to guide lead placement, vector selection, and device programming is superior to current standard of care. The ECG Belt is a noninvasive mapping technology designed to measure beat by beat electrical activation of the left ventricle by utilizing unipolar measurements from multiple ECG electrodes on the body surface. The ECG Belt for CRT response trial is a multicenter, prospective, randomized, investigational pre-market research study conducted at 48 centers in the United States, Canada, and Europe and will randomize approximately 400 subjects. The trial has three arms (enrollment will be 2:1:1, respectively): utilization of the Belt to guide implant as well as postimplant programming, utilizing the Belt to guide postimplant programming alone, and a non-Belt control arm. AdaptivCRT will be an option in the treatment arm but not the control arms. The primary endpoint is change in left ventricular end-systolic volume between preimplant and at 6 months. This paper describes the design and analytic plan for the trial.
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Affiliation(s)
| | - Kevin Jackson
- Duke University Medical Center, Durham, North Carolina
| | - Mauro Biffi
- Policlinico Sant'Orsola-Malpighi, University of Bologna, Bologna, Italy
| | - Kevin Vernooy
- Department of Cardiology, Maastricht Universitair Medisch Centrum, Maastricht, The Netherlands
| | - Alan Bank
- United Heart and Vascular Clinic, St Paul, Minnesota
| | | | | | - Michael R Gold
- Department of Medicine, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
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13
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Salden FCWM, Luermans JGLM, Westra SW, Weijs B, Engels EB, Heckman LIB, Lamerichs LJM, Janssen MHG, Clerx KJH, Cornelussen R, Ghosh S, Prinzen FW, Vernooy K. Short-Term Hemodynamic and Electrophysiological Effects of Cardiac Resynchronization by Left Ventricular Septal Pacing. J Am Coll Cardiol 2020; 75:347-359. [PMID: 32000945 DOI: 10.1016/j.jacc.2019.11.040] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 10/31/2019] [Accepted: 11/08/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) is usually performed by biventricular (BiV) pacing. Previously, feasibility of transvenous implantation of a lead at the left ventricular (LV) endocardial side of the interventricular septum, referred to as LV septal (LVs) pacing, was demonstrated. OBJECTIVES The authors sought to compare the acute electrophysiological and hemodynamic effects of LVs with BiV and His bundle (HB) pacing in CRT patients. METHODS Temporary LVs pacing (transaortic approach) alone or in combination with right ventricular (RV) (LVs+RV), BiV, and HB pacing was performed in 27 patients undergoing CRT implantation. Electrophysiological changes were assessed using electrocardiography (QRS duration), vectorcardiography (QRS area), and multielectrode body surface mapping (standard deviation of activation times [SDAT]). Hemodynamic changes were assessed as the first derivative of LV pressure (LVdP/dtmax). RESULTS As compared with baseline, LVs pacing resulted in a larger reduction in QRS area (to 73 ± 22 μVs) and SDAT (to 26 ± 7 ms) than BiV (to 93 ± 26 μVs and 31 ± 7 ms; both p < 0.05) and LVs+RV pacing (to 108 ± 37 μVs; p < 0.05; and 29 ± 8 ms; p = 0.05). The increase in LVdP/dtmax was similar during LVs and BiV pacing (17 ± 10% vs. 17 ± 9%, respectively) and larger than during LVs+RV pacing (11 ± 9%; p < 0.05). There were no significant differences between basal, mid-, or apical LVs levels in LVdP/dtmax and SDAT. In a subgroup of 16 patients, changes in QRS area, SDAT, and LVdP/dtmax were comparable between LVs and HB pacing. CONCLUSIONS LVs pacing provides short-term hemodynamic improvement and electrical resynchronization that is at least as good as during BiV and possibly HB pacing. These results indicate that LVs pacing may serve as a valuable alternative for CRT.
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Affiliation(s)
- Floor C W M Salden
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands.
| | - Justin G L M Luermans
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - Sjoerd W Westra
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
| | - Bob Weijs
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Elien B Engels
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Luuk I B Heckman
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Léon J M Lamerichs
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Michel H G Janssen
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Kristof J H Clerx
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands
| | - Richard Cornelussen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands; Medtronic PLC, Bakken Research Center, Maastricht, the Netherlands
| | - Subham Ghosh
- Medtronic PLC, Cardiac Rhythm and Heart Failure (CRHF), Mounds View, Minnesota
| | - Frits W Prinzen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, the Netherlands
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center (MUMC+), Maastricht, the Netherlands; Department of Cardiology, Radboud University Medical Centre (Radboudumc), Nijmegen, the Netherlands
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14
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Pereira H, Niederer S, Rinaldi CA. Electrocardiographic imaging for cardiac arrhythmias and resynchronization therapy. Europace 2020; 22:euaa165. [PMID: 32754737 PMCID: PMC7544539 DOI: 10.1093/europace/euaa165] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 05/25/2020] [Indexed: 12/12/2022] Open
Abstract
Use of the 12-lead electrocardiogram (ECG) is fundamental for the assessment of heart disease, including arrhythmias, but cannot always reveal the underlying mechanism or the location of the arrhythmia origin. Electrocardiographic imaging (ECGi) is a non-invasive multi-lead ECG-type imaging tool that enhances conventional 12-lead ECG. Although it is an established technology, its continuous development has been shown to assist in arrhythmic activation mapping and provide insights into the mechanism of cardiac resynchronization therapy (CRT). This review addresses the validity, reliability, and overall feasibility of ECGi for use in a diverse range of arrhythmias. A systematic search limited to full-text human studies published in peer-reviewed journals was performed through Medline via PubMed, using various combinations of three key concepts: ECGi, arrhythmia, and CRT. A total of 456 studies were screened through titles and abstracts. Ultimately, 42 studies were included for literature review. Evidence to date suggests that ECGi can be used to provide diagnostic insights regarding the mechanistic basis of arrhythmias and the location of arrhythmia origin. Furthermore, ECGi can yield valuable information to guide therapeutic decision-making, including during CRT. Several studies have used ECGi as a diagnostic tool for atrial and ventricular arrhythmias. More recently, studies have tested the value of this technique in predicting outcomes of CRT. As a non-invasive method for assessing cardiovascular disease, particularly arrhythmias, ECGi represents a significant advancement over standard procedures in contemporary cardiology. Its full potential has yet to be fully explored.
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Affiliation(s)
- Helder Pereira
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St. Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
- Cardiac Physiology Services—Clinical Investigation Centre, Bupa Cromwell Hospital, London, UK
| | - Steven Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St. Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
| | - Christopher A Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, 4th Floor, Lambeth Wing, St. Thomas’ Hospital, Westminster Bridge Rd, London SE1 7EH, UK
- Cardiovascular Department, Guys and St Thomas NHS Foundation Trust, London, UK
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15
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Bank AJ, Gage RM, Schaefer AE, Burns KV, Brown CD. Electrical wavefront fusion in heart failure patients with left bundle branch block and cardiac resynchronization therapy: Implications for optimization. J Electrocardiol 2020; 61:47-56. [PMID: 32526538 DOI: 10.1016/j.jelectrocard.2020.05.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/11/2020] [Accepted: 05/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Novel metrics of electrical dyssynchrony based on multi-electrode mapping and ECG-based markers of fusion are better predictors of cardiac resynchronization therapy (CRT) response than QRS duration. OBJECTIVE To describe a new methodology for measuring electrical synchrony based on wavefront fusion and electrocardiographic cancellation in patients with CRT and its potential for CRT optimization. METHODS Patients with left bundle branch block (LBBB) type conduction and CRT (n = 84) were studied at multiple device settings using an ECG belt (53 anterior and posterior electrodes). The area between combinations of anterior and posterior curves (AUC) was calculated and cardiac resynchronization index (CRI) defined as percent change in AUC compared to LBBB. RESULTS In 14 patients with complete heart block or atrial fibrillation, CRI at optimal ventriculo-ventricular delay (VVD) (40 ± 19 ms) was significantly higher than with simultaneous biventricular pacing (BiVp) (90 ± 8.6% vs. 54.2 ± 24.2%, p < 0.001). In all 70 patients paced LV-only, LV-paced wavefront was ahead of native wavefront at short atrio-ventricular delay (AVD) and CRI increased with increase in AVD, peaked, and then decreased. Optimal CRI during LV-only pacing was significantly better than optimal CRI with simultaneous BiVp (89.6 ± 8% vs. 64.4 ± 22%, p < 0.001), and occurred at AVD 68 ± 22 ms less than the atrial-RV sensed interval. With sequential BiVp, best CRI was 83.9 ± 13% (with LV preactivation of 40 ± 20 ms). Best CRI at any setting was markedly better than CRI at standard setting (91.6 ± 7.7% vs. 52.7 ± 23.3, p < 0.001). CONCLUSION We describe a novel non-invasive investigational tool that quantifies wavefront fusion and electrical dyssynchrony, and may allow for individualized CRT optimization.
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Affiliation(s)
- Alan J Bank
- United Heart & Vascular Clinic, Research Dept., St. Paul, MN, USA; The University of Minnesota, Department of Biomedical Engineering, Minneapolis, MN, USA.
| | - Ryan M Gage
- United Heart & Vascular Clinic, Research Dept., St. Paul, MN, USA
| | - Antonia E Schaefer
- United Heart & Vascular Clinic, Research Dept., St. Paul, MN, USA; The University of Minnesota, Department of Biomedical Engineering, Minneapolis, MN, USA
| | - Kevin V Burns
- United Heart & Vascular Clinic, Research Dept., St. Paul, MN, USA
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16
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Tung R, Upadhyay GA. Defining Left Bundle Branch Block Patterns in Cardiac Resynchronisation Therapy: A Return to His Bundle Recordings. Arrhythm Electrophysiol Rev 2020; 9:28-33. [PMID: 32637117 PMCID: PMC7330724 DOI: 10.15420/aer.2019.12] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Left bundle branch block (LBBB) is associated with improved outcome after cardiac resynchronisation therapy (CRT). One historical presumption of LBBB has been that the underlying pathophysiology involved diffuse disease throughout the distal conduction system. The ability to normalize wide QRS patterns with His bundle pacing (HBP) has called this notion into question. The determination of LBBB pattern is conventionally made by assessment of surface 12-lead ECGs and can include patients with and without conduction block, as assessed by invasive electrophysiology study (EPS). During a novel extension of the classical EPS to involve left-sided recordings, we found that conduction block associated with the LBBB pattern is most often proximal, usually within the left-sided His fibres, and these patients are the most likely to demonstrate QRS correction with HBP for resynchronisation. Patients with intact Purkinje activation and intraventricular conduction delay are less likely to benefit from HBP. Future EPS are required to determine the impact of newer approaches to conduction system pacing, including intraseptal or left ventricular septal pacing. Left-sided EPS has the potential to refine patient selection in CRT trials and may be used to physiologically phenotype distinct conduction patterns beyond LBBB pattern.
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Affiliation(s)
- Roderick Tung
- Center for Arrhythmia Care, Pritzker School of Medicine, University of Chicago, Chicago, IL, US
| | - Gaurav A Upadhyay
- Center for Arrhythmia Care, Pritzker School of Medicine, University of Chicago, Chicago, IL, US
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17
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Muhammad Sayem AS, Hon Teay S, Shahariar H, Luise Fink P, Albarbar A. Review on Smart Electro-Clothing Systems (SeCSs). SENSORS 2020; 20:s20030587. [PMID: 31973123 PMCID: PMC7037315 DOI: 10.3390/s20030587] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/07/2020] [Accepted: 01/15/2020] [Indexed: 02/02/2023]
Abstract
This review paper presents an overview of the smart electro-clothing systems (SeCSs) targeted at health monitoring, sports benefits, fitness tracking, and social activities. Technical features of the available SeCSs, covering both textile and electronic components, are thoroughly discussed and their applications in the industry and research purposes are highlighted. In addition, it also presents the developments in the associated areas of wearable sensor systems and textile-based dry sensors. As became evident during the literature research, such a review on SeCSs covering all relevant issues has not been presented before. This paper will be particularly helpful for new generation researchers who are and will be investigating the design, development, function, and comforts of the sensor integrated clothing materials.
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Affiliation(s)
| | - Siew Hon Teay
- School of Engineering, Manchester Metropolitan University, Manchester M15 6BH, UK; (S.H.T.); (A.A.)
| | - Hasan Shahariar
- Department of Textile Engineering, Chemistry & Science, North Carolina State University, Raleigh, NC 27606, USA;
| | - Paula Luise Fink
- School of Fashion, Manchester Metropolitan University, Manchester M15 6BG, UK;
| | - Alhussein Albarbar
- School of Engineering, Manchester Metropolitan University, Manchester M15 6BH, UK; (S.H.T.); (A.A.)
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18
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Zhu H, Pan Y, Wu F, Huan R. Optimized Electrode Locations for Wearable Single-Lead ECG Monitoring Devices: A Case Study Using WFEES Modules based on the LANS Method. SENSORS 2019; 19:s19204458. [PMID: 31615163 PMCID: PMC6832916 DOI: 10.3390/s19204458] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 09/27/2019] [Accepted: 10/11/2019] [Indexed: 11/16/2022]
Abstract
Body surface potential mapping (BSPM) is a valuable tool for research regarding electrocardiograms (ECG). However, the BSPM system is limited by its large number of electrodes and wires, long installation time, and high computational complexity. In this paper, we designed a wearable four-electrode electrocardiogram-sensor (WFEES) module that measures six-channel ECGs simultaneously for ECG investigation. To reduce the testing lead number and the measurement complexity, we further proposed a method, the layered (A, N) square-based (LANS) method, to optimize the ECG acquisition and analysis process using WFEES modules for different applications. Moreover, we presented a case study of electrode location optimization for wearable single-lead ECG monitoring devices using WFEES modules with the LANS method. In this study, 102 sets of single-lead ECG data from 19 healthy subjects were analyzed. The signal-to-noise ratio of ECG, as well as the mean and coefficient of variation of QRS amplitude, was derived among different channels to determine the optimal electrode locations. The results showed that a single-lead electrode pair should be placed on the left chest above the electrode location of standard precordial leads V1 to V4. Additionally, the best orientation was the principal diagonal as the direction of the heart's electrical axis.
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Affiliation(s)
- Huaiyu Zhu
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou 310027, China.
| | - Yun Pan
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou 310027, China.
| | - Fan Wu
- Product Department, Hangzhou Proton Technology Co., Ltd., Hangzhou 310012, China.
| | - Ruohong Huan
- College of Computer Science and Technology, Zhejiang University of Technology, Hangzhou 310023, China.
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19
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Abstract
CRT is a cornerstone of therapy for patients with heart failure and reduced ejection fraction. By restoring left ventricular (LV) electrical and mechanical synchrony, CRT can reduce mortality, improve LV function and reduce heart failure symptoms. Since its introduction, many advances have been made that have improved the delivery of and enhanced the response to CRT. Improving CRT outcomes begins with proper patient selection so CRT is delivered to all populations that could benefit from it, and limiting the implantation of CRT in those with a small chance of response. In addition, advancements in LV leads and delivery technologies coupled with multimodality imaging and electrical mapping have enabled operators to place coronary sinus leads in locations that will optimise electrical and mechanical synchrony. Finally, new pacing strategies using LV endocardial pacing or His bundle pacing have allowed for CRT delivery and improved response in patients with poor coronary sinus anatomy or lack of response to traditional CRT.
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Affiliation(s)
- George Thomas
- Department of Medicine, Division of Cardiology, Cornell University Medical Center New York, US
| | - Jiwon Kim
- Department of Medicine, Division of Cardiology, Cornell University Medical Center New York, US
| | - Bruce B Lerman
- Department of Medicine, Division of Cardiology, Cornell University Medical Center New York, US
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20
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Strik M, Ploux S, Jankelson L, Bordachar P. Non-invasive cardiac mapping for non-response in cardiac resynchronization therapy. Ann Med 2019; 51:109-117. [PMID: 31094217 PMCID: PMC7857455 DOI: 10.1080/07853890.2019.1616109] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Cardiac resynchronization therapy (CRT) is an effective intervention in selected patients with moderate-to-severe heart failure with reduced ejection fraction and abnormal left ventricular activation time. The non-response rate of approximately 30% has remained nearly unchanged since this therapy was introduced 25 years ago. While intracardiac mapping is widely used for diagnosis and guidance of therapy in patients with tachyarrhythmia, its application in characterization of the electrical substrate to elucidate the mechanisms involved in CRT response remain anecdotal. In the present review, we describe the traditional determinants of CRT response before presenting novel non-invasive techniques used for CRT optimization. We discuss efforts to identify the target electrical substrate to guide the deployment of pacing electrodes during the operative procedure. Non-invasive body surface mapping technologies such as ECG imaging or ECG belt enables prediction of acute and chronic CRT response. While electrical dyssynchrony parameters provide high predictive accuracy for CRT response when obtained during intrinsic conduction, their predictive value is less when acquired during CRT or LV-pacing. Key messages Classic predictors of CRT response are female gender, NYHA class ≤ III, left ventricular ejection fraction ≥25%, QRS duration ≥150 ms and estimated glomerular filtration rate ≥60 mL/min. ECG-imaging is a comprehensive non-invasive mapping system which allows to express the amount of electrical asynchrony of a CRT candidate. Non-invasive body surface mapping technologies enables excellent prediction of acute and chronic CRT response before implantation. When performed during CRT or LV-pacing, the added value of these mapping systems remains unclear.
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Affiliation(s)
- Marc Strik
- a IHU Liryc , Electrophysiology and Heart Modeling Institute , Bordeaux , France.,b Cardio-Thoracic Unit , Bordeaux University Hospital , Bordeaux , France.,c Maastricht University Medical Center , Cardiovascular Research Institute Maastricht , Maastricht , the Netherlands
| | - Sylvain Ploux
- a IHU Liryc , Electrophysiology and Heart Modeling Institute , Bordeaux , France.,b Cardio-Thoracic Unit , Bordeaux University Hospital , Bordeaux , France
| | - Lior Jankelson
- d Cardiac Electrophysiology, Division of Cardiology, NYU Langone Health , New York University School of Medicine , NY , USA
| | - Pierre Bordachar
- a IHU Liryc , Electrophysiology and Heart Modeling Institute , Bordeaux , France.,b Cardio-Thoracic Unit , Bordeaux University Hospital , Bordeaux , France
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21
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Gage RM, Khan AH, Syed IS, Bajpai A, Burns KV, Curtin AE, Blanchard AL, Gillberg JM, Ghosh S, Bank AJ. Twelve-Lead ECG Optimization of Cardiac Resynchronization Therapy in Patients With and Without Delayed Enhancement on Cardiac Magnetic Resonance Imaging. J Am Heart Assoc 2018; 7:e009559. [PMID: 30571590 PMCID: PMC6405539 DOI: 10.1161/jaha.118.009559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Delayed enhancement (DE) on magnetic resonance imaging is associated with ventricular arrhythmias, adverse events, and worse left ventricular mechanics. We investigated the impact of DE on cardiac resynchronization therapy (CRT) outcomes and the effect of CRT optimization. Methods and Results We studied 130 patients with ejection fraction (EF) ≤40% and QRS ≥120 ms, contrast cardiac magnetic resonance imaging, and both pre‐ and 1‐year post‐CRT echocardiograms. Sixty‐three (48%) patients did not have routine optimization of CRT. The remaining patients were optimized for wavefront fusion by 12‐lead ECG. The primary end point in this study was change in EF following CRT. To investigate the association between electrical dyssynchrony and EF outcomes, the standard deviation of activation times from body‐surface mapping was calculated during native conduction and selected device settings in 52 of the optimized patients. Patients had no DE (n=45), midwall septal stripe (n=30), or scar (n=55). Patients without DE had better ∆EF (13±10 versus 4±10 units; P<0.01). Optimized patients had greater ∆EF in midwall stripe (2±9 versus 12±12 units; P=0.01) and scar (0±7 versus 5±10; P=0.04) groups, but not in the no‐DE group. Patients without DE had greater native standard deviation of activation times (P=0.03) and greater ∆standard deviation of activation times with standard programming (P=0.01). Device optimization reduced standard deviation of activation times only in patients with DE (P<0.01). Conclusions DE on magnetic resonance imaging is associated with worse EF outcomes following CRT. Device optimization is associated with improved EF and reduced electrical dyssynchrony in patients with DE.
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Affiliation(s)
- Ryan M Gage
- 1 United Heart & Vascular Clinic St. Paul MN
| | | | | | | | | | - Antonia E Curtin
- 2 Department of Biomedical Engineering University of Minnesota Minneapolis MN
| | | | | | | | - Alan J Bank
- 1 United Heart & Vascular Clinic St. Paul MN.,2 Department of Biomedical Engineering University of Minnesota Minneapolis MN
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Strik M, Ploux S, Huntjens PR, Nguyên UC, Frontera A, Eschalier R, Dubois R, Ritter P, Klotz N, Vernooy K, Haïssaguerre M, Crijns HJ, Prinzen FW, Bordachar P. Response to cardiac resynchronization therapy is determined by intrinsic electrical substrate rather than by its modification. Int J Cardiol 2018; 270:143-148. [DOI: 10.1016/j.ijcard.2018.06.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/24/2018] [Accepted: 06/04/2018] [Indexed: 11/29/2022]
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Detection of Ventricular Fibrillation Using the Image from Time-Frequency Representation and Combined Classifiers without Feature Extraction. APPLIED SCIENCES-BASEL 2018. [DOI: 10.3390/app8112057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Due the fact that the required therapy to treat Ventricular Fibrillation (V F) is aggressive (electric shock), the lack of a proper detection and recovering therapy could cause serious injuries to the patient or trigger a ventricular fibrillation, or even death. This work describes the development of an automatic diagnostic system for the detection of the occurrence of V F in real time by means of the time-frequency representation (T F R) image of the ECG. The main novelties are the use of the T F R image as input for a classification process, as well as the use of combined classifiers. The feature extraction stage is eliminated and, together with the use of specialized binary classifiers, this method improves the results of the classification. To verify the validity of the method, four different classifiers in different combinations are used: Regression Logistic with L2 Regularization (L 2 R L R), adaptive neural network (A N N C), Bagging (B A G G), and K-nearest neighbor (K N N). The Hierarchical Method (HM) and Voting Majority Method (VMM) combinations are used. ECG signals used for evaluation were obtained from the standard MIT-BIH and AHA databases. When the classifiers were combined, it was observed that the combination of B A G G , K N N , and A N N C using the Hierarchical Method (HM) gave the best results, with a sensitivity of 95.58 ± 0.41%, a 99.31 ± 0.08% specificity, a 98.6 ± 0.04% of overall accuracy, and a precision of 98.25 ± 0.29% for V F . Whereas a sensitivity of 94.02 ± 0.58%, a specificity of 99.31 ± 0.08%, an overall accuracy of 99.14 ± 0.43%, and a precision of 98.59 ± 0.09% was obtained for V T with a run time between 0.07 s and 0.12 s. Results show that the use of T F R image data to feed the combined classifiers yields a reduction in execution time with performance values above to those obtained by individual classifiers. This is of special utility for V F detection in real time.
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Sieniewicz BJ, Gould J, Porter B, Sidhu BS, Behar JM, Claridge S, Niederer S, Rinaldi CA. Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy. Expert Rev Med Devices 2018; 15:555-570. [PMID: 30019954 PMCID: PMC6178093 DOI: 10.1080/17434440.2018.1502084] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/12/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment. AREAS COVERED This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT. EXPERT COMMENTARY Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.
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Affiliation(s)
- Benjamin J. Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Baldeep S Sidhu
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Jonathan M Behar
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Simon Claridge
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Steve Niederer
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
| | - Christopher A. Rinaldi
- Division of Imaging Sciences and Biomedical Engineering, King’s College London, London, United Kingdom
- Cardiology Department, Guys and St Thomas’ NHS Foundation Trust, London, United Kingdom
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Lin AC, Biffi M, Exner DV, Johnson WB, Gras D, Hussin A, Singh B, Yang Z, Hine D, Li S, Crossley GH. Long-term electrical performance of Attain Performa quadripolar left ventricular leads with all steroid-eluting electrodes: Results from a large worldwide clinical trial. Pacing Clin Electrophysiol 2018; 41:920-926. [PMID: 29808920 DOI: 10.1111/pace.13389] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 03/15/2018] [Accepted: 03/25/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Steroid-eluting (SE) electrodes suppress local inflammation and lower pacing capture thresholds (PCT); however, their effectiveness on quadripolar left ventricular (LV) leads in the cardiac vein is not fully studied. We evaluated the effectiveness of SE on all four LV pacing electrodes in human subjects enrolled in the Medtronic Attain® Performa™ quadripolar LV lead study. METHODS A total of 1,097 subjects were included in this evaluation. At each follow-up visit (1, 3, 6, and 12 months), LV PCT and pacing impedance were measured using either manual or automated testing methods. Summary statistics for PCT and impedance values were obtained for implant and each scheduled follow-up visit for all lead models. RESULTS Average extended bipolar (LV electrode to right ventricular Coil) PCTs for the four LV SE pacing electrodes (LV1, LV2, LV3, and LV4) on the three shapes of the quadripolar LV leads were 1.06 ± 0.97 V, 1.38 ± 1.26 V, 1.51 ± 1.33 V, and 2.25 ± 1.63 V, respectively, at 0.5-ms pulse width. PCTs remained low and stable throughout the 12-month follow-up period. CONCLUSION This clinical trial demonstrated that SE on all LV pacing electrodes is associated with low and stable PCTs for all quadripolar LV lead electrodes, resulting in multiple viable vectors for LV pacing. The large number of available vectors facilitates basal pacing, avoidance of PNS, and potentially prolongs generator longevity due to lower PCTs.
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Affiliation(s)
- Albert C Lin
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mauro Biffi
- Insitute of Cardiology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Derek V Exner
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | | | | | - Azlan Hussin
- Department of Cardiology, National Heart Institute, Kuala Lumpur, Malaysia
| | - Balbir Singh
- Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | | | | | - Shelby Li
- Medtronic, plc, Mounds View, MN, USA
| | - George H Crossley
- Vanderbilt Heart and Vascular Institute, Vanderbilt University, Nashville, TN, USA
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Bank AJ, Gage RM, Curtin AE, Burns KV, Gillberg JM, Ghosh S. Body surface activation mapping of electrical dyssynchrony in cardiac resynchronization therapy patients: Potential for optimization. J Electrocardiol 2018; 51:534-541. [DOI: 10.1016/j.jelectrocard.2017.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Indexed: 11/30/2022]
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Bear LR, Huntjens PR, Walton RD, Bernus O, Coronel R, Dubois R. Cardiac electrical dyssynchrony is accurately detected by noninvasive electrocardiographic imaging. Heart Rhythm 2018; 15:1058-1069. [PMID: 29477975 DOI: 10.1016/j.hrthm.2018.02.024] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Poor identification of electrical dyssynchrony is postulated to be a major factor contributing to the low success rate for cardiac resynchronization therapy. OBJECTIVE The purpose of this study was to evaluate the sensitivity of body surface mapping and electrocardiographic imaging (ECGi) to detect electrical dyssynchrony noninvasively. METHODS Langendorff-perfused pig hearts (n = 11) were suspended in a human torso-shaped tank, with left bundle branch block (LBBB) induced through ablation. Recordings were taken simultaneously from a 108-electrode epicardial sock and 128 electrodes embedded in the tank surface during sinus rhythm and ventricular pacing. Computed tomography provided electrode and heart positions in the tank. Epicardial unipolar electrograms were reconstructed from torso potentials using ECGi. Dyssynchrony markers from torso potentials (eg, QRS duration) or ECGi (total activation time, interventricular delay [D-LR], and intraventricular markers) were correlated with those recorded from the sock. RESULTS LBBB was induced (n = 8), and sock-derived activation maps demonstrated interventricular dyssynchrony (D-LR and total activation time) in all cases (P < .05) and intraventricular dyssynchrony for complete LBBB (P < .05) compared to normal sinus rhythm. Only D-LR returned to normal with biventricular pacing (P = .1). Torso markers increased with large degrees of dyssynchrony, and no reduction was seen during biventricular pacing (P > .05). Although ECGi-derived markers were significantly lower than recorded (P < .05), there was a significant strong linear relationship between ECGi and recorded values. ECGi correctly diagnosed electrical dyssynchrony and interventricular resynchronization in all cases. The latest site of activation was identified to 9.1 ± 0.6 mm by ECGi. CONCLUSION ECGi reliably and accurately detects electrical dyssynchrony, resynchronization by biventricular pacing, and the site of latest activation, providing more information than do body surface potentials.
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Affiliation(s)
- Laura R Bear
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, Pessac, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, France; Inserm, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, France.
| | - Peter R Huntjens
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, Pessac, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, France; Inserm, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, France; CARIM School for Cardiovascular Diseases, Maastricht University MedicalCentre, Maastricht, The Netherlands
| | - Richard D Walton
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, Pessac, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, France; Inserm, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, France
| | - Olivier Bernus
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, Pessac, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, France; Inserm, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, France
| | - Ruben Coronel
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, Pessac, France; Department of Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Rémi Dubois
- Electrophysiology and Heart Modelling Institute (IHU-LIRYC), Fondation Bordeaux Université, Pessac, France; Université de Bordeaux, Centre de Recherche Cardio-Thoracique de Bordeaux U1045, France; Inserm, U1045, Centre de Recherche Cardio-Thoracique de Bordeaux, France
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Auricchio A, Prinzen FW. Enhancing Response in the Cardiac Resynchronization Therapy Patient. JACC Clin Electrophysiol 2017; 3:1203-1219. [DOI: 10.1016/j.jacep.2017.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/02/2017] [Accepted: 08/10/2017] [Indexed: 12/17/2022]
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Daubert C, Mabo P, Leclercq C. Do novel noninvasive ECG techniques improve patient selection for CRT? Heart Rhythm 2017; 14:400-401. [DOI: 10.1016/j.hrthm.2016.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Indexed: 10/20/2022]
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