Sylvain Ploux1, Joost Lumens2, Zachary Whinnett3, Michel Montaudon4, Maria Strom5, Charu Ramanathan5, Nicolas Derval4, Adlane Zemmoura4, Arnaud Denis4, Maxime De Guillebon4, Ashok Shah4, Mélèze Hocini4, Pierre Jaïs4, Philippe Ritter4, Michel Haïssaguerre4, Bruce L Wilkoff6, Pierre Bordachar4. 1. Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, Bordeaux, France. Electronic address: sylvain.ploux@free.fr. 2. Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, Bordeaux, France; Maastricht University, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands. 3. Imperial College London, London, United Kingdom. 4. Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, LIRYC, L'Institut de rythmologie et modélisation cardiaque, Université de Bordeaux, Bordeaux, France. 5. CardioInsight Technologies Inc., Cleveland, Ohio. 6. Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract
OBJECTIVES: This study sought to investigate whether noninvasive electrocardiographic activation mapping is a useful method for predicting response to cardiac resynchronization therapy (CRT). BACKGROUND: One third of the patients appear not to respond to CRT when they are selected according to QRS duration. METHODS: We performed electrocardiographic activation mapping in 33 consecutive CRT candidates (QRS duration ≥120 ms). In 18 patients, the 12-lead electrocardiographic morphology was left bundle branch block (LBBB), and in 15, it was nonspecific intraventricular conduction disturbance (NICD). Three indexes of electrical dyssynchrony were derived from intrinsic maps: right and left ventricular total activation times and ventricular electrical uncoupling (VEU) (difference between the left ventricular [LV] and right ventricular mean activation times). We assessed the ability of these parameters to predict response, measured using a clinical composite score, after 6 months of CRT. RESULTS: Electrocardiographic maps revealed homogeneous patterns of activation and consistently greater VEU and LV total activation time (LVTAT) in patients with LBBB compared with heterogeneous activation sequences and shorter VEU and LVTAT in NICD patients (VEU: 75 ± 12 ms vs. 40 ± 22 ms; p < 0.001; LVTAT: 115 ± 21 ms vs. 91 ± 34 ms; p = 0.03). LBBB and NICD patients had similar right ventricular total activation times (62 ± 30 ms vs. 58 ± 26 ms; p = 0.7). The area under the receiver-operating characteristic curve indicated that VEU (area under the curve [AUC]: 0.88) was significantly superior to QRS duration (AUC: 0.73) and LVTAT (AUC: 0.72) for predicting CRT response (p < 0.05). With a 50-ms cutoff value, VEU identified CRT responders with 90% sensitivity and 82% specificity whether LBBB was present or not. CONCLUSIONS: Ventricular electrical uncoupling measured by electrocardiographic mapping predicted clinical CRT response better than QRS duration or the presence of LBBB.
OBJECTIVES: This study sought to investigate whether noninvasive electrocardiographic activation mapping is a useful method for predicting response to cardiac resynchronization therapy (CRT). BACKGROUND: One third of the patients appear not to respond to CRT when they are selected according to QRS duration. METHODS: We performed electrocardiographic activation mapping in 33 consecutive CRT candidates (QRS duration ≥120 ms). In 18 patients, the 12-lead electrocardiographic morphology was left bundle branch block (LBBB), and in 15, it was nonspecific intraventricular conduction disturbance (NICD). Three indexes of electrical dyssynchrony were derived from intrinsic maps: right and left ventricular total activation times and ventricular electrical uncoupling (VEU) (difference between the left ventricular [LV] and right ventricular mean activation times). We assessed the ability of these parameters to predict response, measured using a clinical composite score, after 6 months of CRT. RESULTS: Electrocardiographic maps revealed homogeneous patterns of activation and consistently greater VEU and LV total activation time (LVTAT) in patients with LBBB compared with heterogeneous activation sequences and shorter VEU and LVTAT in NICD patients (VEU: 75 ± 12 ms vs. 40 ± 22 ms; p < 0.001; LVTAT: 115 ± 21 ms vs. 91 ± 34 ms; p = 0.03). LBBB and NICD patients had similar right ventricular total activation times (62 ± 30 ms vs. 58 ± 26 ms; p = 0.7). The area under the receiver-operating characteristic curve indicated that VEU (area under the curve [AUC]: 0.88) was significantly superior to QRS duration (AUC: 0.73) and LVTAT (AUC: 0.72) for predicting CRT response (p < 0.05). With a 50-ms cutoff value, VEU identified CRT responders with 90% sensitivity and 82% specificity whether LBBB was present or not. CONCLUSIONS: Ventricular electrical uncoupling measured by electrocardiographic mapping predicted clinical CRT response better than QRS duration or the presence of LBBB.
Authors: Larisa G Tereshchenko; Alan Cheng; Jason Park; Nicholas Wold; Timothy E Meyer; Michael R Gold; Suneet Mittal; Jagmeet Singh; Kenneth M Stein; Kenneth A Ellenbogen Journal: Heart Rhythm Date: 2015-08-10 Impact factor: 6.343
Authors: Joost Lumens; Sylvain Ploux; Marc Strik; John Gorcsan; Hubert Cochet; Nicolas Derval; Maria Strom; Charu Ramanathan; Philippe Ritter; Michel Haïssaguerre; Pierre Jaïs; Theo Arts; Tammo Delhaas; Frits W Prinzen; Pierre Bordachar Journal: J Am Coll Cardiol Date: 2013-09-04 Impact factor: 24.094
Authors: A W Maurits van der Graaf; Pranav Bhagirath; Hemanth Ramanna; Vincent J H M van Driel; Jacques de Hooge; Natasja M S de Groot; Marco J W Götte Journal: Ann Noninvasive Electrocardiol Date: 2014-02-19 Impact factor: 1.468