Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response: site of latest left ventricular activation relative to pacing site

被引：22

作者：

Parreira, Leonor ^{[1
]}

Tsyganov, Alexey ^{[2
,3
]}

Artyukhina, Elena ^{[4
]}

Vernooy, Kevin ^{[5
]}

Tondo, Claudio ^{[6
]}

Adragao, Pedro ^{[1
]}

Ascione, Ciro ^{[6
]}

Carmo, Pedro ^{[1
]}

Carvalho, Salome ^{[1
]}

Egger, Matthias ^{[7
]}

Ferreira, Antonio ^{[1
]}

Ghossein, Mohammed ^{[5
]}

Holm, Magnus ^{[7
]}

Kalinin, Vitaly ^{[7
]}

Malakhova, Maria ^{[3
]}

Meine, Mathias ^{[8
]}

Nunes, Silvia ^{[1
]}

Podolyak, Dmitry ^{[3
]}

Revishvili, Amiran ^{[4
]}

Shapieva, Albina ^{[3
]}

Stepanova, Vera ^{[9
]}

van Stipdonk, Antonius ^{[5
]}

Taymasova, Irina ^{[4
]}

Wouters, Philippe ^{[8
]}

Zubarev, Stepan ^{[10
]}

Leyva, Francisco ^{[11
]}

Auricchio, Angelo ^{[12
]}

Varma, Niraj ^{[13
]}

机构：

[1] Hosp Luz SA, Dept Electrophysiol, Lisbon, Portugal

[2] IM Sechenov First Moscow State Med Univ, Moscow, Russia

[3] Petrovsky Natl Res Ctr Surg, Moscow, Russia

[4] AV Vishnevsky Natl Med Res Ctr Surg, Moscow, Russia

[5] Maastricht Univ Med Ctr, Cardiovasc Res Inst Maastricht CARIM, Dept Cardiol, Maastricht, Netherlands

[6] Ctr Cardiol Monzino IRCCS, Heart Rhythm Ctr, Milan, Italy

[7] EP Solut SA, Yverdon, Switzerland

[8] Univ Med Ctr Utrecht, Heart & Lung Div, Utrecht, Netherlands

[9] North Western State Med Univ, St Petersburg, Russia

[10] Almazov Natl Med Res Ctr, St Petersburg, Russia

[11] Aston Univ, Queen Elizabeth Hosp, Dept Cardiol, Birmingham, Warwick, England

[12] Ist Cardioctr Ticino, Div Cardiol, Ente Ospedaliero Cantonale, Lugano, Switzerland

[13] Cleveland Clin, Dept Cardiovasc Med, 2977 Essex Rd, Cleveland Hts, OH 44195 USA

来源：

EUROPACE | 2023年 / 25卷 / 04期

关键词：

Cardiac resynchronization therapy; Heart failure; Non-invasive 3D electrical activation mapping; Electrocardiographic imaging; ECGI; Ischaemic cardiomyopathy; Dilated cardiomyopathy; HEART-FAILURE; PATIENT; LEAD; ECHOCARDIOGRAPHY; PLACEMENT;

D O I：

10.1093/europace/euad041

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 (d(p)) 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 d(p). 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. d(p) was 42 +/- 23 mm [31 +/- 14 mm for responders vs. 63 +/- 24 mm non-responders (P < 0.001)]. Longer d(p) and the lack of use of CRT optimization algorithm were the only independent predictors of non-response [area under the curve (AUC) 0.906]. d(p) 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.

引用

页码：1458 / 1466

页数：9

共 19 条

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