Ryan M Gage1, Antonia E Curtin2, Kevin V Burns1, Subham Ghosh3, Jeffrey M Gillberg3, Alan J Bank4. 1. United Heart & Vascular Clinic, St. Paul, Minnesota. 2. University of Minnesota, Minneapolis, Minnesota. 3. Medtronic plc, Mounds View, Minnesota. 4. United Heart & Vascular Clinic, St. Paul, Minnesota; University of Minnesota, Minneapolis, Minnesota,. Electronic address: alan.bank@allina.com.
Abstract
BACKGROUND: Electrical activation is important in cardiac resynchronization therapy (CRT) response. Standard electrocardiographic analysis may not accurately reflect the heterogeneity of electrical activation. OBJECTIVE: We compared changes in left ventricular size and function after CRT to native electrical dyssynchrony and its change during pacing. METHODS: Body surface isochronal maps using 53 anterior and posterior electrodes as well as 12-lead electrocardiograms were acquired after CRT in 66 consecutive patients. Electrical dyssynchrony was quantified using standard deviation of activation times (SDAT). Ejection fraction (EF) and left ventricular end-systolic volume (LVESV) were measured before CRT and at 6 months. Multiple regression evaluated predictors of response. RESULTS: ∆LVESV correlated with ∆SDAT (P = .007), but not with ∆QRS duration (P = .092). Patients with SDAT ≥35 ms had greater increase in EF (13 ± 8 units vs 4 ± 9 units; P < .001) and LVESV (-34% ± 28% vs -13% ± 29%; P = .005). Patients with ≥10% improvement in SDAT had greater ∆EF (11 ± 9 units vs 4 ± 9 units; P = .010) and ∆LVESV (-33% ± 26% vs -6% ± 34%; P = .001). SDAT ≥35 ms predicted ∆EF, while ∆SDAT, sex, and left bundle branch block predicted ∆LVESV. In 34 patients without class I indication for CRT, SDAT ≥35 ms (P = .015) and ∆SDAT ≥10% (P = .032) were the only predictors of ∆EF. CONCLUSION: Body surface mapping of SDAT and its changes predicted CRT response better than did QRS duration. Body surface mapping may potentially improve selection or optimization of CRT patients. Copyright Â
BACKGROUND: Electrical activation is important in cardiac resynchronization therapy (CRT) response. Standard electrocardiographic analysis may not accurately reflect the heterogeneity of electrical activation. OBJECTIVE: We compared changes in left ventricular size and function after CRT to native electrical dyssynchrony and its change during pacing. METHODS: Body surface isochronal maps using 53 anterior and posterior electrodes as well as 12-lead electrocardiograms were acquired after CRT in 66 consecutive patients. Electrical dyssynchrony was quantified using standard deviation of activation times (SDAT). Ejection fraction (EF) and left ventricular end-systolic volume (LVESV) were measured before CRT and at 6 months. Multiple regression evaluated predictors of response. RESULTS: ∆LVESV correlated with ∆SDAT (P = .007), but not with ∆QRS duration (P = .092). Patients with SDAT ≥35 ms had greater increase in EF (13 ± 8 units vs 4 ± 9 units; P < .001) and LVESV (-34% ± 28% vs -13% ± 29%; P = .005). Patients with ≥10% improvement in SDAT had greater ∆EF (11 ± 9 units vs 4 ± 9 units; P = .010) and ∆LVESV (-33% ± 26% vs -6% ± 34%; P = .001). SDAT ≥35 ms predicted ∆EF, while ∆SDAT, sex, and left bundle branch block predicted ∆LVESV. In 34 patients without class I indication for CRT, SDAT ≥35 ms (P = .015) and ∆SDAT ≥10% (P = .032) were the only predictors of ∆EF. CONCLUSION: Body surface mapping of SDAT and its changes predicted CRT response better than did QRS duration. Body surface mapping may potentially improve selection or optimization of CRT patients. Copyright Â
Authors: Ryan M Gage; Akbar H Khan; Imran S Syed; Ambareesh Bajpai; Kevin V Burns; Antonia E Curtin; Amanda L Blanchard; Jeffrey M Gillberg; Subham Ghosh; Alan J Bank Journal: J Am Heart Assoc Date: 2018-12-04 Impact factor: 5.501
Authors: Kazi T Haq; Nichole M Rogovoy; Jason A Thomas; Christopher Hamilton; Katherine J Lutz; Ashley Wirth; Aron B Bender; David M German; Ryle Przybylowicz; Peter van Dam; Thomas A Dewland; Khidir Dalouk; Eric Stecker; Babak Nazer; Peter M Jessel; Karen S MacMurdy; Ignatius Gerardo E Zarraga; Bassel Beitinjaneh; Charles A Henrikson; Merritt Raitt; Cristina Fuss; Maros Ferencik; Larisa G Tereshchenko Journal: Heart Rhythm O2 Date: 2021-06-29