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Sieniewicz BJ, Jackson T, Claridge S, Pereira H, Gould J, Sidhu B, Porter B, Niederer S, Yao C, Rinaldi CA. Optimization of CRT programming using non-invasive electrocardiographic imaging to assess the acute electrical effects of multipoint pacing. J Arrhythm 2019; 35:267-275. [PMID: 31007792 PMCID: PMC6457383 DOI: 10.1002/joa3.12153] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/13/2018] [Indexed: 12/07/2022] Open
Abstract
Aim Quadripolar lead technology and multi-point pacing (MPP) are important clinical adjuncts in cardiac resynchronization therapy (CRT) pacing aimed at reducing the rate of non-response to therapy. Mixed results have been achieved using MPP and it is critical to identify which patients require this approach and how to configure their MPP stimulation, in order to achieve optimal electrical resynchronization. Methods & Results We sought to investigate whether electrocardiographic imaging (ECGi), using the CARDIOINSIGHT ™ inverse ECG mapping system, could identify alterations in electrical resynchronization during different methods of device optimization. In no patient did a single form of programming optimization provide the best electrical response. The effects of utilizing MPP were idiosyncratic and highly patient specific. ECGi activation maps were clearly able to discern changes in bulk LV activation during differing MPP programming. In two of the five subjects, MPP resulted in more rapid activation of the left ventricle compared to standard CRT; however, in the remaining three patients, the use of MPP did not appear to acutely improve electrical resynchronization. Crucially, this cohort showed evidence of extensive LV scarring which was well visualized using both CMR and ECGi voltage mapping. Conclusions Our work suggests a potential role for ECGi in the optimization of non-responders to CRT, as it allows the fusion of activation maps and scar analysis above and beyond interrogation of the 12 lead ECG.
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Affiliation(s)
- Benjamin J Sieniewicz
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Tom Jackson
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Simon Claridge
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Helder Pereira
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK
| | - Justin Gould
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Baldeep Sidhu
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Bradley Porter
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
| | - Steve Niederer
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK
| | - Cheng Yao
- CardioInsight Technologies, Medtronic Minneapolis Minnesota
| | - Christopher A Rinaldi
- Division of Imaging Sciences and Biomedical Engineering King's College London London UK.,Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK
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Boyle PM, Hakim JB, Zahid S, Franceschi WH, Murphy MJ, Vigmond EJ, Dubois R, Haïssaguerre M, Hocini M, Jaïs P, Trayanova NA, Cochet H. Comparing Reentrant Drivers Predicted by Image-Based Computational Modeling and Mapped by Electrocardiographic Imaging in Persistent Atrial Fibrillation. Front Physiol 2018; 9:414. [PMID: 29725307 PMCID: PMC5917348 DOI: 10.3389/fphys.2018.00414] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 04/04/2018] [Indexed: 02/06/2023] Open
Abstract
Electrocardiographic mapping (ECGI) detects reentrant drivers (RDs) that perpetuate arrhythmia in persistent AF (PsAF). Patient-specific computational models derived from late gadolinium-enhanced magnetic resonance imaging (LGE-MRI) identify all latent sites in the fibrotic substrate that could potentially sustain RDs, not just those manifested during mapped AF. The objective of this study was to compare RDs from simulations and ECGI (RDsim/RDECGI) and analyze implications for ablation. We considered 12 PsAF patients who underwent RDECGI ablation. For the same cohort, we simulated AF and identified RDsim sites in patient-specific models with geometry and fibrosis distribution from pre-ablation LGE-MRI. RDsim- and RDECGI-harboring regions were compared, and the extent of agreement between macroscopic locations of RDs identified by simulations and ECGI was assessed. Effects of ablating RDECGI/RDsim were analyzed. RDsim were predicted in 28 atrial regions (median [inter-quartile range (IQR)] = 3.0 [1.0; 3.0] per model). ECGI detected 42 RDECGI-harboring regions (4.0 [2.0; 5.0] per patient). The number of regions with RDsim and RDECGI per individual was not significantly correlated (R = 0.46, P = ns). The overall rate of regional agreement was fair (modified Cohen's κ0 statistic = 0.11), as expected, based on the different mechanistic underpinning of RDsim- and RDECGI. nineteen regions were found to harbor both RDsim and RDECGI, suggesting that a subset of clinically observed RDs was fibrosis-mediated. The most frequent source of differences (23/32 regions) between the two modalities was the presence of RDECGI perpetuated by mechanisms other than the fibrotic substrate. In 6/12 patients, there was at least one region where a latent RD was observed in simulations but was not manifested during clinical mapping. Ablation of fibrosis-mediated RDECGI (i.e., targets in regions that also harbored RDsim) trended toward a higher rate of positive response compared to ablation of other RDECGI targets (57 vs. 41%, P = ns). Our analysis suggests that RDs in human PsAF are at least partially fibrosis-mediated. Substrate-based ablation combining simulations with ECGI could improve outcomes.
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Affiliation(s)
- Patrick M Boyle
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Joe B Hakim
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Sohail Zahid
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - William H Franceschi
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Michael J Murphy
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Edward J Vigmond
- L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France
| | - Rémi Dubois
- L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France
| | - Michel Haïssaguerre
- L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France
| | - Mélèze Hocini
- L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France
| | - Pierre Jaïs
- L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France
| | - Natalia A Trayanova
- Department of Biomedical Engineering, Institute for Computational Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Hubert Cochet
- L'Institut de RYthmologie et Modélisation Cardiaque (IHU-LIRYC), Pessac-Bordeaux, France.,Centre Hospitalier Universitaire de Bordeaux, Pessac-Bordeaux, France
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Affiliation(s)
- Vadim V Fedorov
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio.
| | - Brian J Hansen
- Department of Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Cochet H, Dubois R, Yamashita S, Al Jefairi N, Berte B, Sellal JM, Hooks D, Frontera A, Amraoui S, Zemoura A, Denis A, Derval N, Sacher F, Corneloup O, Latrabe V, Clément-Guinaudeau S, Relan J, Zahid S, Boyle PM, Trayanova NA, Bernus O, Montaudon M, Laurent F, Hocini M, Haïssaguerre M, Jaïs P. Relationship Between Fibrosis Detected on Late Gadolinium-Enhanced Cardiac Magnetic Resonance and Re-Entrant Activity Assessed With Electrocardiographic Imaging in Human Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2017; 4:17-29. [PMID: 29479568 DOI: 10.1016/j.jacep.2017.07.019] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study sought to assess the relationship between fibrosis and re-entrant activity in persistent atrial fibrillation (AF). BACKGROUND The mechanisms involved in sustaining re-entrant activity during AF are poorly understood. METHODS Forty-one patients with persistent AF (age 56 ± 12 years; 6 women) were evaluated. High-resolution electrocardiographic imaging (ECGI) was performed during AF by using a 252-chest electrode array, and phase mapping was applied to locate re-entrant activity. Sites of high re-entrant activity were defined as re-entrant regions. Late gadolinium-enhanced (LGE) cardiac magnetic resonance (CMR) was performed at 1.25 × 1.25 × 2.5 mm resolution to characterize atrial fibrosis and measure atrial volumes. The relationship between LGE burden and the number of re-entrant regions was analyzed. Local LGE density was computed and characterized at re-entrant sites. All patients underwent catheter ablation targeting re-entrant regions, the procedural endpoint being AF termination. Clinical, CMR, and ECGI predictors of acute procedural success were then analyzed. RESULTS Left atrial (LA) LGE burden was 22.1 ± 5.9% of the wall, and LA volume was 74 ± 21 ml/m2. The number of re-entrant regions was 4.3 ± 1.7 per patient. LA LGE imaging was significantly associated with the number of re-entrant regions (R = 0.52, p = 0.001), LA volume (R = 0.62, p < 0.0001), and AF duration (R = 0.54, p = 0.0007). Regional analysis demonstrated a clustering of re-entrant activity at LGE borders. Areas with high re-entrant activity showed higher local LGE density as compared with the remaining atrial areas (p < 0.0001). Failure to achieve AF termination during ablation was associated with higher LA LGE burden (p < 0.001), higher number of re-entrant regions (p < 0.001), and longer AF duration (p = 0.008). CONCLUSIONS The number of re-entrant regions during AF relates to the extent of LGE on CMR, with the location of these regions clustering to LGE areas. These characteristics affect procedural outcomes of ablation.
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Affiliation(s)
- Hubert Cochet
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Rémi Dubois
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Seigo Yamashita
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
| | - Nora Al Jefairi
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
| | - Benjamin Berte
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
| | - Jean-Marc Sellal
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
| | - Darren Hooks
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
| | - Antonio Frontera
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
| | - Sana Amraoui
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Adlane Zemoura
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Arnaud Denis
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Nicolas Derval
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Frederic Sacher
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Olivier Corneloup
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
| | - Valérie Latrabe
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
| | | | | | - Sohail Zahid
- Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Patrick M Boyle
- Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Natalia A Trayanova
- Institute for Computational Medicine, Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland
| | - Olivier Bernus
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Michel Montaudon
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - François Laurent
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Mélèze Hocini
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Michel Haïssaguerre
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
| | - Pierre Jaïs
- Haut-Lévêque Cardiology Hospital, Bordeaux University Hospital Center, University of Bordeaux, France
- National Institute for Health and Medical Research (INSERM) U1045 - Electrophysiology and Heart Modeling Institute, Bordeaux, France
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Lumens J, Ploux S, Strik M, Gorcsan J, Cochet H, Derval N, Strom M, Ramanathan C, Ritter P, Haïssaguerre M, Jaïs P, Arts T, Delhaas T, Prinzen FW, Bordachar P. Comparative electromechanical and hemodynamic effects of left ventricular and biventricular pacing in dyssynchronous heart failure: electrical resynchronization versus left-right ventricular interaction. J Am Coll Cardiol 2013; 62:2395-2403. [PMID: 24013057 DOI: 10.1016/j.jacc.2013.08.715] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/11/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The purpose of this study was to enhance understanding of the working mechanism of cardiac resynchronization therapy by comparing animal experimental, clinical, and computational data on the hemodynamic and electromechanical consequences of left ventricular pacing (LVP) and biventricular pacing (BiVP). BACKGROUND It is unclear why LVP and BiVP have comparative positive effects on hemodynamic function of patients with dyssynchronous heart failure. METHODS Hemodynamic response to LVP and BiVP (% change in maximal rate of left ventricular pressure rise [LVdP/dtmax]) was measured in 6 dogs and 24 patients with heart failure and left bundle branch block followed by computer simulations of local myofiber mechanics during LVP and BiVP in the failing heart with left bundle branch block. Pacing-induced changes of electrical activation were measured in dogs using contact mapping and in patients using a noninvasive multielectrode electrocardiographic mapping technique. RESULTS LVP and BiVP similarly increased LVdP/dtmax in dogs and in patients, but only BiVP significantly decreased electrical dyssynchrony. In the simulations, LVP and BiVP increased total ventricular myofiber work to the same extent. While the LVP-induced increase was entirely due to enhanced right ventricular (RV) myofiber work, the BiVP-induced increase was due to enhanced myofiber work of both the left ventricle (LV) and RV. Overall, LVdP/dtmax correlated better with total ventricular myofiber work than with LV or RV myofiber work alone. CONCLUSIONS Animal experimental, clinical, and computational data support the similarity of hemodynamic response to LVP and BiVP, despite differences in electrical dyssynchrony. The simulations provide the novel insight that, through ventricular interaction, the RV myocardium importantly contributes to the improvement in LV pump function induced by cardiac resynchronization therapy.
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Affiliation(s)
- Joost Lumens
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | - Sylvain Ploux
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France; Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Marc Strik
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - John Gorcsan
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Hubert Cochet
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Nicolas Derval
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | | | | | - Philippe Ritter
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Pierre Jaïs
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
| | - Theo Arts
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Tammo Delhaas
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Frits W Prinzen
- Maastricht University Medical Center, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands
| | - Pierre Bordachar
- Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, L'Institut de rythmologie et modélisation cardiaque (LIRYC), Université Bordeaux, Bordeaux, France
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