Electrical dyssynchrony mapping and cardiac resynchronization therapy

Bank, Alan J.; Brown, Christopher D.; Burns, Kevin V.; Espinosa, Emanuel A.; Harbin, Michelle M.

doi:10.1016/j.jelectrocard.2022.08.006

Cited by 4 publications

(6 citation statements)

References 17 publications

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“…The methodology and protocol for measurement of CRI have previously been described in detail. 4 In brief, 2 standard ECG machines (MAC 5500HD, GE Healthcare) were used to Short AVD in these patients was defined as a AVD < 50% of PR interval.…”

Section: Study Protocolmentioning

confidence: 99%

“…During simultaneous BiV pacing, the effect of AVD on electrical synchrony is more complicated as compared to LV-only pacing because the AVD determines which right-sided electrical wavefront(s) fuses with the LVp wavefront. 4,5 We have previously shown that at short AVD electrical resynchronization is solely from fusion of RVp and LVp wavefronts. We confirm this finding during both atrial sensing and atrial pacing.…”

Section: Savd and Pavd Programming With Simultaneous Biv Pacingmentioning

confidence: 99%

“…We have developed a noninvasive, electrocardiographic methodology (based on the concept of wavefront fusion) for quantifying electrical synchrony during CRT over a wide-range of clinically relevant and practical AVDs and ventricular-ventricular delays (VVD) called electrical dyssynchrony mapping (EDM). 4,5 Optimization of CRT programming using this methodology in nonresponders and incomplete responders resulted in significant improvements in LV size, systolic function and mechanical dyssynchrony. 6 In the present study we describe how this methodology for measuring electrical dyssynchrony can be used to better understand the physiology of wavefront fusion during atrial sensing/pacing, and how it can be used to determine the electrically optimal SAVD/PAVD offset during LV-only pacing and BiV pacing.…”

Section: Introductionmentioning

confidence: 99%

“…We have developed a noninvasive, electrocardiographic methodology (based on the concept of wavefront fusion) for quantifying electrical synchrony during CRT over a wide‐range of clinically relevant and practical AVDs and ventricular‐ventricular delays (VVD) called electrical dyssynchrony mapping (EDM) 4,5 . Optimization of CRT programming using this methodology in nonresponders and incomplete responders resulted in significant improvements in LV size, systolic function and mechanical dyssynchrony 6 …”

Section: Introductionmentioning

confidence: 99%

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Determination of sensed and paced atrial‐ventricular delay in cardiac resynchronization therapy

Bank,

Brown,

Burns

et al. 2024

Pacing Clinical Electrophis

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BackgroundOptimization of atrial‐ventricular delay (AVD) during atrial sensing (SAVD) and pacing (PAVD) provides the most effective cardiac resynchronization therapy (CRT). We demonstrate a novel electrocardiographic methodology for quantifying electrical synchrony and optimizing SAVD/PAVD.MethodsWe studied 40 CRT patients with LV activation delay. Atrial‐sensed to RV‐sensed (As‐RVs) and atrial‐paced to RV‐sensed (Ap‐RVs) intervals were measured from intracardiac electrograms (IEGM). LV‐only pacing was performed over a range of SAVD/PAVD settings. Electrical dyssynchrony (cardiac resynchronization index; CRI) was measured at each setting using a multilead ECG system placed over the anterior and posterior torso. Biventricular pacing, which included multiple interventricular delays, was also conducted in a subset of 10 patients.ResultsWhen paced LV‐only, peak CRI was similar (93 ± 5% vs. 92 ± 5%) during atrial sensing or pacing but optimal PAVD was 61 ± 31 ms greater than optimal SAVD. The difference between As‐RVs and Ap‐RVs intervals on IEGMs (62 ± 31 ms) was nearly identical. The slope of the correlation line (0.98) and the correlation coefficient r (0.99) comparing the 2 methods of assessing SAVD‐PAVD offset were nearly 1 and the y‐intercept (0.63 ms) was near 0. During simultaneous biventricular (BiV) pacing at short AVD, SAVD and PAVD programming did not affect CRI, but CRI was significantly (p < .05) lower during atrial sensing at long AVD.ConclusionsA novel methodology for measuring electrical dyssynchrony was used to determine electrically optimal SAVD/PAVD during LV‐only pacing. When BiV pacing, shorter AVDs produce better electrical synchrony.

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Section: Study Protocolmentioning

confidence: 99%

Section: Savd and Pavd Programming With Simultaneous Biv Pacingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Determination of sensed and paced atrial‐ventricular delay in cardiac resynchronization therapy

Bank,

Brown,

Burns

et al. 2024

Pacing Clinical Electrophis

Self Cite

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“…The other, more feasible step of LV pacing optimization is post-procedural choice of active pacing sites among the two, four or multiple sites that are available depending on the LV lead configuration (22,12,23).…”

Section: Ml-based Optimization Of LV Pacing Site In Crtmentioning

confidence: 99%

Combination of personalized computational modeling and machine-learning for optimization of left ventricular pacing site in cardiac resynchronization therapy

Dokuchaev

Chumarnaya

Bazhutina

et al. 2022

Preprint

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Background: Up to 30-50% of selected patients with chronic heart failure do not respond to cardiac resynchronization therapy (CRT). Optimization of pacing lead placement in ventricles remains a challenge. Objective: We utilize a machine learning (ML) classifier to predict the position of an optimal left ventricular (LV) pacing site maximizing the probability of CRT response for a certain patient. Materials and Methods: Retrospective data from 57 patients with implanted CRT devices were utilized. Positive response to CRT was defined by a 10% improvement in the LV ejection fraction in a year after implantation. For each patient, a personalized model of ventricular activation and ECG was developed based on MRI and CT images. The total ventricular activation time, QRS duration and electrical dyssynchrony indices during intrinsic rhythm and biventricular (BiV) pacing with clinical pacing lead position (ref-LP) were computed and used in combination with clinical data to train the ML algorithm. We built a logistic regression classifier predicting CRT response with a high ROC AUC=0.84 and an average accuracy of 0.77. It generates a ML-score estimating the probability of CRT response. ML-scores were computed from model-driven features for varying LV pacing sites. Then Bayesian optimization was used to interpolate the ML-score over the available LV surface and an optimal LV lead position for BiV pacing that maximizes ML-score (ML-LP) was defined. Results: The optimal LV pacing site position increased the average ML-score by 17% in the patient cohort. Moreover, 11 out of 34 (20%) non-responders classified as true negative at ref-LP were re-classified as positive at ML-LP. In a patient group (n=14, 25% of the cohort) with LV pacing lead deployed in close proximity to the optimal position, the ratio of responders to non-responders was three times higher than in the entire cohort. Conclusion: We have developed a new technique based on simulations and ML to define an optimal position for LV lead for BiV pacing maximizing the ML-score of CRT response on the available LV epicardial surface. This technique demonstrates a high potential for the improvement of CRT outcome with guided lead implantation.

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Cardiac resynchronization therapy optimization in nonresponders and incomplete responders using electrical dyssynchrony mapping

Brown¹,

Burns²,

Harbin³

et al. 2022

Heart Rhythm

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Electrical dyssynchrony mapping and cardiac resynchronization therapy

Cited by 4 publications

References 17 publications

Determination of sensed and paced atrial‐ventricular delay in cardiac resynchronization therapy

Determination of sensed and paced atrial‐ventricular delay in cardiac resynchronization therapy

Combination of personalized computational modeling and machine-learning for optimization of left ventricular pacing site in cardiac resynchronization therapy

Cardiac resynchronization therapy optimization in nonresponders and incomplete responders using electrical dyssynchrony mapping

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