Parreira, Leonor, Tsyganov, Alexey, Artyukhina, Elena, Vernooy, Kevin, Tondo, Claudio, Adragao, Pedro, Ascione, Ciro, Carmo, Pedro, Carvalho, Salomé, Egger, Matthias, Ferreira, Antonio, Ghossein, Mohammed, Holm, Magnus, Kalinin, Vitaly, Malakhova, Maria, Meine, Mathias, Nunes, Silvia, Podolyak, Dmitry, Revishvili, Amiran, Shapieva, Albina, Stepanova, Vera, van Stipdonk, Antonius, Taymasova, Irina, Wouters, Philippe, Zubarev, Stepan, Leyva, Francisco, Auricchio, Angelo and Varma, Niraj (2023). Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response::site of latest left ventricular activation relative to pacing site. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 25 (4), pp. 1458-1466.
Abstract
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 AND RESULTS: Consecutive CRT patients underwent ECGI and chest/heart computed tomography 6-24 months of post-implant. Latest electrically activated site and the distance to LVPS (dp) 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 dp. 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. dp was 42 ± 23 mm [31 ± 14 mm for responders vs. 63 ± 24 mm non-responders (P < 0.001)]. Longer dp and the lack of use of CRT optimization algorithm were the only independent predictors of non-response [area under the curve (AUC) 0.906]. dp 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. Non-invasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.
Publication DOI: | https://doi.org/10.1093/europace/euad041 |
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Divisions: | College of Health & Life Sciences > Aston Medical School > Translational Medicine Research Group (TMRG) College of Health & Life Sciences > Aston Medical School |
Additional Information: | 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 |
Uncontrolled Keywords: | Non-invasive 3D electrical activation mapping,Electrocardiographic imaging,ECGI,Heart failure,Cardiac resynchronization therapy,Dilated cardiomyopathy,Ischaemic cardiomyopathy |
Publication ISSN: | 1532-2092 |
Last Modified: | 06 Aug 2024 09:44 |
Date Deposited: | 15 Mar 2023 08:36 |
Full Text Link: | |
Related URLs: |
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(Publisher URL) http://www.scop ... tnerID=8YFLogxK (Scopus URL) |
PURE Output Type: | Article |
Published Date: | 2023-04 |
Published Online Date: | 2023-03-01 |
Accepted Date: | 2023-01-04 |
Submitted Date: | 2022-11-09 |
Authors: |
Parreira, Leonor
Tsyganov, Alexey Artyukhina, Elena Vernooy, Kevin Tondo, Claudio Adragao, Pedro Ascione, Ciro Carmo, Pedro Carvalho, Salomé Egger, Matthias Ferreira, Antonio Ghossein, Mohammed Holm, Magnus Kalinin, Vitaly Malakhova, Maria Meine, Mathias Nunes, Silvia Podolyak, Dmitry Revishvili, Amiran Shapieva, Albina Stepanova, Vera van Stipdonk, Antonius Taymasova, Irina Wouters, Philippe Zubarev, Stepan Leyva, Francisco Auricchio, Angelo Varma, Niraj |