TY - JOUR
T1 - Dispersion of repolarization increases with cardiac resynchronization therapy and is associated with left ventricular reverse remodeling
AU - Elliott, Mark K.
AU - Strocchi, Marina
AU - Mehta, Vishal S.
AU - Wijesuriya, Nadeev
AU - Mannakkara, Nilanka N.
AU - Jackson, Tom
AU - Pereira, Helder
AU - Behar, Jonathan M.
AU - Bishop, Martin J.
AU - Niederer, Steven
AU - Rinaldi, Christopher A.
N1 - Funding Information:
The study was supported by CardioInsight Inc. and the Wellcome/EPSRC Centre for Medical Engineering [ WT203148/Z/16/Z ]. Outside of the submitted work, MKE and VSM have received fellowship funding from Abbott. SN acknowledges support from the UK Engineering and Physical Sciences Research Council ( EP/M012492/1 , NS/A000049/1 , EP/P01268X/1 ), the BHF ( PG/15/91/31812 , PG/13/37/30280 , SP/18/6/33805 ), US NIH ( NIH R01-HL152256 ), ERC ( ERC PREDICT-HF 864055 ) and Kings Health Partners London NIHR Biomedical Research Centre . MJB acknowledges support from BHF (PG/18/74/34077) and a Wellcome Trust Innovator Award (213,342/Z/18/Z). CAR receives research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics and MicroPort outside of the submitted work.
Funding Information:
The study was supported by CardioInsight Inc. and the Wellcome/EPSRC Centre for Medical Engineering [WT203148/Z/16/Z]. Outside of the submitted work, MKE and VSM have received fellowship funding from Abbott. SN acknowledges support from the UK Engineering and Physical Sciences Research Council (EP/M012492/1, NS/A000049/1, EP/P01268X/1), the BHF (PG/15/91/31812, PG/13/37/30280, SP/18/6/33805), US NIH (NIH R01-HL152256), ERC (ERC PREDICT-HF 864055) and Kings Health Partners London NIHR Biomedical Research Centre. MJB acknowledges support from BHF (PG/18/74/34077) and a Wellcome Trust Innovator Award (213,342/Z/18/Z). CAR receives research funding and/or consultation fees from Abbott, Medtronic, Boston Scientific, Spectranetics and MicroPort outside of the submitted work.
Publisher Copyright:
© 2022 The Authors
PY - 2022/5/1
Y1 - 2022/5/1
N2 - Purpose: Cardiac resynchronization therapy (CRT) reduces ventricular activation times and electrical dyssynchrony, however the effect on repolarization is unclear. In this study, we sought to investigate the effect of CRT and left ventricular (LV) remodeling on dispersion of repolarization using electrocardiographic imaging (ECGi). Methods: 11 patients with heart failure and electrical dyssynchrony underwent ECGi 1-day and 6-months post CRT. Reconstructed epicardial electrograms were used to create maps of activation time, repolarization time (RT) and activation recovery intervals (ARI) and calculate measures of RT, ARI and their dispersion. ARI was corrected for heart rate (cARI). Results: Compared to baseline rhythm, LV cARI dispersion was significantly higher at 6 months (28.2 ± 7.7 vs 36.4 ± 7.2 ms; P = 0.03) but not after 1 day (28.2 ± 7.7 vs 34.4 ± 6.8 ms; P = 0.12). There were no significant differences from baseline to CRT for mean LV cARI or RT metrics. Significant LV remodeling (>15% reduction in end-systolic volume) was an independent predictor of increase in LV cARI dispersion (P = 0.04) and there was a moderate correlation between the degree of LV remodeling and the relative increase in LV cARI dispersion (R = -0.49) though this was not statistically significant (P = 0.12). Conclusion: CRT increases LV cARI dispersion, but this change was not fully apparent until 6 months post implant. The effects of CRT on LV cARI dispersion appeared to be dependent on LV reverse remodeling, which is in keeping with evidence that the risk of ventricular arrhythmia after CRT is higher in non-responders compared to responders.
AB - Purpose: Cardiac resynchronization therapy (CRT) reduces ventricular activation times and electrical dyssynchrony, however the effect on repolarization is unclear. In this study, we sought to investigate the effect of CRT and left ventricular (LV) remodeling on dispersion of repolarization using electrocardiographic imaging (ECGi). Methods: 11 patients with heart failure and electrical dyssynchrony underwent ECGi 1-day and 6-months post CRT. Reconstructed epicardial electrograms were used to create maps of activation time, repolarization time (RT) and activation recovery intervals (ARI) and calculate measures of RT, ARI and their dispersion. ARI was corrected for heart rate (cARI). Results: Compared to baseline rhythm, LV cARI dispersion was significantly higher at 6 months (28.2 ± 7.7 vs 36.4 ± 7.2 ms; P = 0.03) but not after 1 day (28.2 ± 7.7 vs 34.4 ± 6.8 ms; P = 0.12). There were no significant differences from baseline to CRT for mean LV cARI or RT metrics. Significant LV remodeling (>15% reduction in end-systolic volume) was an independent predictor of increase in LV cARI dispersion (P = 0.04) and there was a moderate correlation between the degree of LV remodeling and the relative increase in LV cARI dispersion (R = -0.49) though this was not statistically significant (P = 0.12). Conclusion: CRT increases LV cARI dispersion, but this change was not fully apparent until 6 months post implant. The effects of CRT on LV cARI dispersion appeared to be dependent on LV reverse remodeling, which is in keeping with evidence that the risk of ventricular arrhythmia after CRT is higher in non-responders compared to responders.
KW - Cardiac memory
KW - Cardiac resynchronization therapy
KW - Electrical remodeling
KW - Electrocardiographic imaging
KW - Repolarization
KW - Ventricular arrhythmias
UR - http://www.scopus.com/inward/record.url?scp=85129234133&partnerID=8YFLogxK
U2 - 10.1016/j.jelectrocard.2022.04.001
DO - 10.1016/j.jelectrocard.2022.04.001
M3 - Article
C2 - 35468456
AN - SCOPUS:85129234133
SN - 0022-0736
VL - 72
SP - 120
EP - 127
JO - Journal of Electrocardiology
JF - Journal of Electrocardiology
ER -