Electrical dyssynchrony mapping and cardiac resynchronization therapy

ElsevierVolume 74, September–October 2022, Pages 73-81Journal of ElectrocardiologyHighlights•

A non-invasive method of assessing cardiac electrical synchrony is described.

Synchrony over a range of cardiac resynchronization device settings is mapped.

Optimal device settings can be found, potentially improving patient outcomes.

Timing of RV-paced, LV-paced and native electrical wavefronts can be quantified.

Lack of resynchronization over the entire map suggests poor lead position.

AbstractPurpose

There is no clinical methodology for quantification or display of electrical dyssynchrony over a wide range of atrial-ventricular delays (AVD) and ventricular-ventricular delays (VVD) in patients with cardiac resynchronization therapy (CRT). This study aimed to develop a new methodology, based on wavefront fusion, for mapping electrical synchrony.

Methods

A cardiac resynchronization index (CRI) was measured at multiple device settings in 90 patients. Electrical dyssynchrony maps (EDM) were constructed for each patient to display CRI at any combination of AVD and VVD. An optimal synchrony line (OSL) depicted the AVD/VVD combinations producing the highest CRIs. Fusion of right ventricular paced (RVp), left ventricular paced (LVp), and native wavefront offsets were calculated.

Results

CRI significantly increased (p < 0.0001) from 58.0 ± 28.1% at baseline to 98.3 ± 1.7% at optimized settings. EDMs in patients with high-grade heart block (n = 20) had an OSL parallel to the simultaneous biventricular pacing (BiVPVV-SIM) line with leftward shift across all AVDs (RVp-LVpOFFSET = 50.5 ± 29.8 ms). EDMs in patients with intact AV node conduction (n = 64) had an OSL parallel to the BiVPVV-SIM line with leftward shift at short AVDs (RVp-LVpOFFSET = 33.4 ± 23.3 ms), curvilinear at intermediate AVDs (triple fusion), and vertical at long AVDs (native-LVpOFFSET = 85.2 ± 22.8 ms) in all patients except those with poor LV lead position (n = 6).

Conclusion

A new methodology is described for quantifying and graphing electrical dyssynchrony over a physiologic range of AVDs/VVDs. This methodology offers a noninvasive, practical, clinical approach for measuring electrical synchrony that could be applied to optimization of CRT devices.

Keywords

Cardiac resynchronization therapy

Electrical dyssynchrony

Optimization

Electrocardiography

Wavefront fusion

AbbreviationsA-LVINTERVAL

atrial sensed/paced to LV paced interval

A-RVINTERVAL

atrial sensed/ paced to RV paced interval

ApRVs

atrial paced RV sensed

AsRVs

atrial sensed RV sensed

BiVPVV-SIM

simultaneous biventricular pacing

BiVPVV-SEQ

sequential biventricular pacing

CRI

cardiac resynchronization index

EDM

electrical dyssynchrony mapping

L-IVCD

interventricular conduction delay with LV activation delay

OSL

optimal synchrony line

Native-LVpOFFSET

Native to LV paced timing offset

Native-RVpOFFSET

Native to RV paced timing offset

RVp-LVpOFFSET

RV paced to LV paced timing offset

© 2022 The Authors. Published by Elsevier Inc.

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