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

Leonor Parreira; Alexey Tsyganov; Elena Artyukhina; Kevin Vernooy; Claudio Tondo; Pedro Adragão; Ciro Ascione; Pedro Carmo; Salomé Carvalho; Matthias Egger; António Ferreira; Mohammed Ghossein; Magnus Holm; Vitaly Kalinin; Maria Malakhova; Mathias Meine; Silvia Nunes; Dmitry Podolyak; Amiran Revishvili; Albina Shapieva; Vera Stepanova; Antonius van Stipdonk; Irina Taymasova; Philippe Wouters; Stepan Zubarev; Francisco Leyva; Angelo Auricchio; Niraj Varma

doi:10.1093/europace/euad041

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

Leonor Parreira
, Alexey Tsyganov
, Elena Artyukhina
, Kevin Vernooy
, Claudio Tondo
, Pedro Adragão
, Ciro Ascione
, Pedro Carmo
, Salomé Carvalho
, Matthias Egger
, António Ferreira
, Mohammed Ghossein
, Magnus Holm
, Vitaly Kalinin
, Maria Malakhova
, Mathias Meine
, Silvia Nunes
, Dmitry Podolyak
, Amiran Revishvili
, Albina Shapieva

Vera Stepanova, Antonius van Stipdonk, Irina Taymasova, Philippe Wouters, Stepan Zubarev, Francisco Leyva, Angelo Auricchio, Niraj Varma^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

25 Citations (Scopus)

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 Consecutive CRT patients underwent ECGI and chest/heart computed tomography 6-24 months of post-implant. Latest and results 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. Noninvasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.

Original language	English
Pages (from-to)	1458-1466
Number of pages	9
Journal	Europace
Volume	25
Issue number	4
DOIs	https://doi.org/10.1093/europace/euad041
Publication status	Published - 1 Apr 2023
Externally published	Yes

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Cardiac resynchronization therapy
Dilated cardiomyopathy
ECGI
Electrocardiographic imaging
Heart failure
Ischaemic cardiomyopathy
Non-invasive 3D electrical activation mapping

Access to Document

10.1093/europace/euad041Licence: CC BY-NC

Cite this

Parreira, L., Tsyganov, A., Artyukhina, E., Vernooy, K., Tondo, C., Adragão, 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., ... Varma, N. (2023). Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response: site of latest left ventricular activation relative to pacing site. Europace, 25(4), 1458-1466. https://doi.org/10.1093/europace/euad041

@article{b25bde083a814d46a41ae08512eecde2,

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

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 Consecutive CRT patients underwent ECGI and chest/heart computed tomography 6-24 months of post-implant. Latest and results 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. Noninvasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.",

keywords = "Cardiac resynchronization therapy, Dilated cardiomyopathy, ECGI, Electrocardiographic imaging, Heart failure, Ischaemic cardiomyopathy, Non-invasive 3D electrical activation mapping",

author = "Leonor Parreira and Alexey Tsyganov and Elena Artyukhina and Kevin Vernooy and Claudio Tondo and Pedro Adrag{\~a}o and Ciro Ascione and Pedro Carmo and Salom{\'e} Carvalho and Matthias Egger and Ant{\'o}nio Ferreira and Mohammed Ghossein and Magnus Holm and Vitaly Kalinin and Maria Malakhova and Mathias Meine and Silvia Nunes and Dmitry Podolyak and Amiran Revishvili and Albina Shapieva and Vera Stepanova and \{van Stipdonk\}, Antonius and Irina Taymasova and Philippe Wouters and Stepan Zubarev and Francisco Leyva and Angelo Auricchio and Niraj Varma",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected].",

year = "2023",

month = apr,

day = "1",

doi = "10.1093/europace/euad041",

language = "English",

volume = "25",

pages = "1458--1466",

journal = "Europace",

issn = "1099-5129",

publisher = "Oxford University Press",

number = "4",

}

Parreira, L, Tsyganov, A, Artyukhina, E, Vernooy, K, Tondo, C, Adragão, 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 2023, 'Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response: site of latest left ventricular activation relative to pacing site', Europace, vol. 25, no. 4, pp. 1458-1466. https://doi.org/10.1093/europace/euad041

Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response: site of latest left ventricular activation relative to pacing site. / Parreira, Leonor; Tsyganov, Alexey; Artyukhina, Elena et al.
In: Europace, Vol. 25, No. 4, 01.04.2023, p. 1458-1466.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response

T2 - site of latest left ventricular activation relative to pacing site

AU - Parreira, Leonor

AU - Tsyganov, Alexey

AU - Artyukhina, Elena

AU - Vernooy, Kevin

AU - Tondo, Claudio

AU - Adragão, Pedro

AU - Ascione, Ciro

AU - Carmo, Pedro

AU - Carvalho, Salomé

AU - Egger, Matthias

AU - Ferreira, António

AU - Ghossein, Mohammed

AU - Holm, Magnus

AU - Kalinin, Vitaly

AU - Malakhova, Maria

AU - Meine, Mathias

AU - Nunes, Silvia

AU - Podolyak, Dmitry

AU - Revishvili, Amiran

AU - Shapieva, Albina

AU - Stepanova, Vera

AU - van Stipdonk, Antonius

AU - Taymasova, Irina

AU - Wouters, Philippe

AU - Zubarev, Stepan

AU - Leyva, Francisco

AU - Auricchio, Angelo

AU - Varma, Niraj

N1 - Publisher Copyright: © The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [email protected].

PY - 2023/4/1

Y1 - 2023/4/1

N2 - 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 Consecutive CRT patients underwent ECGI and chest/heart computed tomography 6-24 months of post-implant. Latest and results 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. Noninvasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.

AB - 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 Consecutive CRT patients underwent ECGI and chest/heart computed tomography 6-24 months of post-implant. Latest and results 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. Noninvasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.

KW - Cardiac resynchronization therapy

KW - Dilated cardiomyopathy

KW - ECGI

KW - Electrocardiographic imaging

KW - Heart failure

KW - Ischaemic cardiomyopathy

KW - Non-invasive 3D electrical activation mapping

UR - https://www.scopus.com/pages/publications/85152632684

U2 - 10.1093/europace/euad041

DO - 10.1093/europace/euad041

M3 - Article

C2 - 36857597

AN - SCOPUS:85152632684

SN - 1099-5129

VL - 25

SP - 1458

EP - 1466

JO - Europace

JF - Europace

IS - 4

ER -

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

Abstract

UN SDGs

Keywords

Access to Document

Other files and links

Fingerprint

Cite this