Aims The standard deviation of activation time (SDAT) derived from body surface maps (BSMs) has been proposed as an optimal measure of electrical dyssynchrony in patients with cardiac resynchronization therapy (CRT). The goal of this study was two-fold: (i) to compare the values of SDAT in individual CRT patients with reconstructed myocardial metrics of depolarization heterogeneity using an inverse solution algorithm and (ii) to compare SDAT calculated from 96-lead BSM with a clinically easily applicable 12-lead electrocardiogram (ECG). Methods and results Cardiac resynchronization therapy patients with sinus rhythm and left bundle branch block at baseline (n = 19, 58% males, age 60 ± 11 years, New York Heart Association Classes II and III, QRS 167 ± 16) were studied using a 96-lead BSM. The activation time (AT) was automatically detected for each ECG lead, and SDAT was calculated using either 96 leads or standard 12 leads. Standard deviation of activation time was assessed in sinus rhythm and during six different pacing modes, including atrial pacing, sequential left or right ventricular, and biventricular pacing. Changes in SDAT calculated both from BSM and from 12-lead ECG corresponded to changes in reconstructed myocardial ATs. A high degree of reliability was found between SDAT values obtained from 12-lead ECG and BSM for different pacing modes, and the intraclass correlation coefficient varied between 0.78 and 0.96 (P < 0.001). Conclusion Standard deviation of activation time measurement from BSM correlated with reconstructed myocardial ATs, supporting its utility in the assessment of electrical dyssynchrony in CRT. Importantly, 12-lead ECG provided similar information as BSM. Further prospective studies are necessary to verify the clinical utility of SDAT from 12-lead ECG in larger patient cohorts, including those with ischaemic cardiomyopathy.
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant agency AZV, Ministry of Health of the Czech Republic Background Quantification of electrical dyssynchrony would allow optimization of lead placement and timing in patients with CRT. The standard deviation of activation times (SDAT) derived from body surface maps (BSM) was proposed as a measure of electrical dyssynchrony in CRT patients. However, SDAT derived from standard 12-lead ECG would be clinically preferred. Objective To evaluate and compare the SDAT measured from BSM and 12-lead ECG for assessment of electrical resynchronization in patients with implanted CRT. Methods CRT patients with sinus rhythm and LBBB at baseline (n=19, 58% males; age 60±11 years; NYHA class II-III; QRS 160±29) were studied using 96-lead BSM. For each ECG lead, the activation time was automatically detected and SDAT was calculated using either 96 leads or standard 12 leads. Electrical dyssynchrony was assessed during native sinus rhythm and 6 different pacing modes (see figure). Results SDAT calculated from BSM and 12-lead ECG decreased during optimal BiV pacing as compared to sinus rhythm by 26% (p=0.006) and 30% (p=0.003), respectively. The two other BiV setups showed also a decrease in SDAT values. Importantly, a high degree of reliability was found between values of SDAT obtained from12-lead ECG and 96-lead BSM for different pacing modes, the intraclass correlation coefficient was 0.8 to 0.9 (95% CI 0.7 - 0.9, p<0.001). Conclusion SDAT assessment is considered an important metric of electrical dyssynchrony in CRT. Our results suggest that 12-lead ECG provides similar results as BSM and thus, allows simplification of the measurement. Further prospective studies are necessary to verify the clinical utility of SDAT from 12-lead ECG.
Inverse ECG imaging methods typically require 32–250 leads to create body surface potential maps (BSPM), limiting their routine clinical use. This study evaluated the accuracy of PaceView inverse ECG method to localize the left or right ventricular (LV and RV, respectively) pacing leads using either a 99-lead BSPM or the 12-lead ECG. A 99-lead BSPM was recorded in patients with cardiac resynchronization therapy (CRT) during sinus rhythm and sequential LV/RV pacing. The non-contrast CT was performed to localize precisely both ECG electrodes and CRT leads. From a BSPM, nine signals were selected to obtain the 12-lead ECG. Both BSPM and 12-lead ECG were used to localize the RV and LV lead, and the localization error was calculated. Consecutive patients with dilated cardiomyopathy, previously implanted with a CRT device, were enrolled (n = 19). The localization error for the RV/LV lead was 9.0 [IQR 4.8–13.6] / 7.7 [IQR 0.0–10.3] mm using the 12-lead ECG and 9.1 [IQR 5.4–15.7] / 9.8 [IQR 8.6–13.1] mm for the BSPM. Thus, the noninvasive lead localization using the 12-lead ECG was accurate enough and comparable to 99-lead BSPM, potentially increasing the capability of 12-lead ECG for the optimization of the LV/RV pacing sites during CRT implant or for the most favorable programming.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.