1
|
Parreira L, Tsyganov A, Artyukhina E, Vernooy K, Tondo C, Adragao P, Ascione C, Carmo P, Carvalho S, Egger M, Ferreira A, Ghossein M, Holm M, Kalinin V, Malakhova M, Meine M, Nunes S, Podolyak D, Revishvili A, Shapieva A, Stepanova V, van Stipdonk A, Taymasova I, Wouters P, Zubarev S, Leyva F, Auricchio A, Varma N. Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response: site of latest left ventricular activation relative to pacing site. Europace 2023; 25:1458-1466. [PMID: 36857597 PMCID: PMC10105854 DOI: 10.1093/europace/euad041] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/04/2023] [Indexed: 03/03/2023] Open
Abstract
AIMS Pacing remote from the latest electrically activated site (LEAS) in the left ventricle (LV) may diminish response to cardiac resynchronization therapy (CRT). We tested whether proximity of LV pacing site (LVPS) to LEAS, determined by non-invasive three-dimensional electrical activation mapping [electrocardiographic Imaging (ECGI)], increased likelihood of CRT response. METHODS AND RESULTS Consecutive CRT patients underwent ECGI and chest/heart computed tomography 6-24 months of post-implant. Latest electrically activated site and the distance to LVPS (dp) were assessed. Left ventricular end-systolic volume (LVESV) reduction of ≥15% at clinical follow-up defined response. Logistic regression probabilistically modelled non-response; variables included demographics, heart failure classification, left bundle branch block (LBBB), ischaemic heart disease (IHD), atrial fibrillation, QRS duration, baseline ejection fraction (EF) and LVESV, comorbidities, use of CRT optimization algorithm, angiotensin-converting enzyme inhibitor(ACE)/angiotensin-receptor blocker (ARB), beta-blocker, diuretics, and dp. Of 111 studied patients [64 ± 11 years, EF 28 ± 6%, implant duration 12 ± 5 months (mean ± SD), 98% had LBBB, 38% IHD], 67% responded at 10 ± 3 months post CRT-implant. Latest electrically activated sites were outside the mid-to-basal lateral segments in 35% of the patients. dp was 42 ± 23 mm [31 ± 14 mm for responders vs. 63 ± 24 mm non-responders (P < 0.001)]. Longer dp and the lack of use of CRT optimization algorithm were the only independent predictors of non-response [area under the curve (AUC) 0.906]. dp of 47 mm delineated responders and non-responders (AUC 0.931). CONCLUSION The distance between LV pacing site and latest electrical activation is a strong independent predictor for CRT response. Non-invasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.
Collapse
Affiliation(s)
- Leonor Parreira
- Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal
| | - Alexey Tsyganov
- I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.,Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Elena Artyukhina
- A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation
| | - Kevin Vernooy
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Pedro Adragao
- Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal
| | - Ciro Ascione
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Pedro Carmo
- Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal
| | - Salomé Carvalho
- Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal
| | | | - Antonio Ferreira
- Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal
| | - Mohammed Ghossein
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Magnus Holm
- EP Solutions SA, Yverdon-les-Bains, Switzerland
| | | | - Maria Malakhova
- Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Mathias Meine
- Heart and Lung Division, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Silvia Nunes
- Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal
| | - Dmitry Podolyak
- Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Amiran Revishvili
- A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation
| | - Albina Shapieva
- Petrovsky National Research Centre of Surgery, Moscow, Russian Federation
| | - Vera Stepanova
- North-Western State Medical University, Saint-Petersburg, Russian Federation
| | - Antonius van Stipdonk
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Irina Taymasova
- A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation
| | - Philippe Wouters
- Heart and Lung Division, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Stepan Zubarev
- Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
| | - Francisco Leyva
- Department of Cardiology, Queen Elizabeth Hospital, Aston University,, Birmingham, UK
| | - Angelo Auricchio
- Division of Cardiology, Istituto Cardiocentro Ticino, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Niraj Varma
- Department of Cardiovascular Medicine, Cleveland Clinic, 2977 Essex Road, Cleveland Heights, OH, USA
| |
Collapse
|