Non Invasive Electrocardiographic Assessment of Ventricular Activation and Remodeling Response to Cardiac Resynchronization Therapy: ECG Imaging and Response to CRT

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Abstract

Background. CRT produces acute changes in electric resynchronization which can be measured non-invasively with electrocardiographic body surface mapping (ECGi). The relation between baseline acute electrophysiology metrics and their manipulation with CRT and reverse remodeling is unclear. Objective. To test (ECGi) derived parameters of electrical activation as predictors of volumetric response to CRT. Methods. ECGi was performed in 21 patients directly following CRT implant. Activation parameters (LVtat, VVtat, VVsync and LV dispersion of activation times) were measured at baseline and following echocardiographically optimized CRT. Remodeling response (>15% reduction LVESV) was assessed 6 months post CRT Results. Patients were aged 68.9±12.1, 81% were male and 57% were ischemic. Baseline measures of dyssynchrony were more pronounced in LBBB vs non LBBB. ECGi demonstrated a trend of greater interventricular dyssynchrony between responders and non-responders that did not reach statistical significance.(VVsync: -45.7±22.4 vs. -25.1±29.3ms, p=0.227). Remaining activation parameters were similar between responders and non-responders (VVtat 101±22.0 vs. 98.9±23.4ms, p=0.838; LVtat 86.4±17.1 vs. 85.1±27.7ms, p=0.904; LVdisp 28.2±6.3 vs. 27.0±8.7ms, p=0.726). In volumetric responders activation parameters were significantly improved with CRT compared to non-responders: VV sync (-45.67±22.41 vs 2.33±18.87, P=0.001), VVtat (101±22.04 vs 71±14.01ms, p=0.002), LVtat (86.44±17.15 vs 67.67±11.31, p=0.006) and LVdisp (28.22±6.3 vs 21.56±4.45, p=0.008). Conclusion Baseline ECGi activation times did not predict CRT volumetric response. Volumetric responders exhibited significant improvements in ECGi derived metrics with CRT. ECGi does not select CRT candidates but may be a useful adjunct to guide LV lead implants and to perform post implant CRT optimization.
Original languageEnglish
JournalHeart Rhythm O2
Early online date11 Jan 2021
DOIs
Publication statusE-pub ahead of print - 11 Jan 2021

Keywords

  • Heart Failure
  • Cardiac Resynchronisation Therapy
  • Body surface mapping
  • ECG imaging
  • LV activation mapping

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