Marc Strik1, Sylvain Ploux2, Peter R Huntjens3, Uyên Châu Nguyên4, Antionio Frontera2, Romain Eschalier5, Remi Dubois2, Philippe Ritter2, Nicholas Klotz2, Kevin Vernooy6, Michel Haïssaguerre2, Harry J G M Crijns4, Frits W Prinzen4, Pierre Bordachar2. 1. IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands. Electronic address: m.strik@maastrichtuniversity.nl. 2. IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France. 3. IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, F-33600 Pessac, Bordeaux, France; Bordeaux University Hospital (CHU), Cardio-Thoracic Unit, F-33600 Pessac, France; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands. 4. Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands. 5. Centre Hospitalier Universitaire Clermont-Ferrand, Clermont-Ferrand, France. 6. Maastricht University Medical Center, Cardiovascular Research Institute Maastricht, Maastricht, the Netherlands; Radboud University Medical Center, Nijmegen, the Netherlands.
Abstract
BACKGROUND: Electrocardiographic mapping (ECM) expresses electrical substrate through magnitude and direction of the activation delay vector (ADV). We investigated to what extent the response to cardiac resynchronization therapy (CRT) is determined by baseline ADV and by ADV modification through CRT and optimization of left ventricular (LV) pacing site. METHODS: ECM was performed in 79 heart failure patients (4 RBBB, 12 QRS < 120 ms, 23 non-specific conduction delay [NICD] and 40 left bundle branch block [LBBB]). 67 patients (QRS ≥ 120 ms) underwent CRT implantation and in 26 patients multiple LV pacing site optimization was performed. ADV was calculated from locations/depolarization times of 2000 virtual epicardial electrodes derived from ECM. Acute response was defined as ≥10% LVdP/dtmax increase, chronic response by composite clinical score at 6 months. RESULTS: During intrinsic conduction, ADV direction was similar in patients with QRS < 120 ms, NICD and LBBB, pointing towards the LV free wall, while ADV magnitude was larger in LBBB (117 ± 25 ms) than in NICD (70 ± 29 ms, P < 0.05) and QRS < 120 ms (52 ± 14 ms, P < 0.05). Intrinsic ADV accurately predicted the acute (AUC = 0.93) and chronic (AUC = 0.90) response to CRT. ADV change by CRT only moderately predicted response (highest AUC = 0.76). LV pacing site optimization had limited effects: +3 ± 4% LVdP/dtmax when compared to conventional basolateral LV pacing. CONCLUSION: The baseline electrical substrate, adequately measured by ADV amplitude, strongly determines acute and chronic CRT response, while the extent of its modification by conventional CRT or by varying LV pacing sites has limited effects.
BACKGROUND: Electrocardiographic mapping (ECM) expresses electrical substrate through magnitude and direction of the activation delay vector (ADV). We investigated to what extent the response to cardiac resynchronization therapy (CRT) is determined by baseline ADV and by ADV modification through CRT and optimization of left ventricular (LV) pacing site. METHODS: ECM was performed in 79 heart failurepatients (4 RBBB, 12 QRS < 120 ms, 23 non-specific conduction delay [NICD] and 40 left bundle branch block [LBBB]). 67 patients (QRS ≥ 120 ms) underwent CRT implantation and in 26 patients multiple LV pacing site optimization was performed. ADV was calculated from locations/depolarization times of 2000 virtual epicardial electrodes derived from ECM. Acute response was defined as ≥10% LVdP/dtmax increase, chronic response by composite clinical score at 6 months. RESULTS: During intrinsic conduction, ADV direction was similar in patients with QRS < 120 ms, NICD and LBBB, pointing towards the LV free wall, while ADV magnitude was larger in LBBB (117 ± 25 ms) than in NICD (70 ± 29 ms, P < 0.05) and QRS < 120 ms (52 ± 14 ms, P < 0.05). Intrinsic ADV accurately predicted the acute (AUC = 0.93) and chronic (AUC = 0.90) response to CRT. ADV change by CRT only moderately predicted response (highest AUC = 0.76). LV pacing site optimization had limited effects: +3 ± 4% LVdP/dtmax when compared to conventional basolateral LV pacing. CONCLUSION: The baseline electrical substrate, adequately measured by ADV amplitude, strongly determines acute and chronic CRT response, while the extent of its modification by conventional CRT or by varying LV pacing sites has limited effects.
Authors: Brett D Atwater; Kasper Emerek; Peter L Sørensen; Steen M Hansen; Zak Loring; Claus Graff; Christoffer Polcwiartek; Joseph Kisslo; Peter Søgaard; Daniel J Friedman Journal: Pacing Clin Electrophysiol Date: 2019-09-22 Impact factor: 1.976
Authors: Josef Halamek; Pavel Leinveber; Ivo Viscor; Radovan Smisek; Filip Plesinger; Vlastimil Vondra; Jolana Lipoldova; Magdalena Matejkova; Pavel Jurak Journal: PLoS One Date: 2019-05-31 Impact factor: 3.240