Electrocardiogram Belt guidance for left ventricular lead placement and biventricular pacing optimization

Rickard, John; Jackson, Kevin; Gold, Michael R.; Biffi, Mauro; Ziacchi, Matteo; Silverstein, Joshua; Ramza, Brian; Metzl, Mark; Grubman, Eric; Abben, Richard; Varma, Niraj; Tabbal, Ghiyath; Jensen, Cory D.; Wouters, Griet; Ghosh, Subham; Vernooy, Kevin

doi:10.1016/j.hrthm.2022.11.015

Cited by 10 publications

(10 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, a recent prospective controlled randomized trial failed to demonstrate improvement in CRT response using BSPM to guide LV lead placement based on the metrics of a reduction in ventricular standard deviation of activation time or LV total activation time. 12 This may be because of limited array of electrodes, lack of anatomical registration, and/or ineffective metrics of electrical resynchronization. In this study, detailed ECGI mapping in conjunction with anatomical registration enabled identification of the site of latest electrical LV activation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

et al. 2023

Self Cite

View full text Add to dashboard Cite

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 (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. Non-invasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.

show abstract

Section: Discussionmentioning

confidence: 99%

“…A simplified method acquiring a limited array of body surface potential mapping (BSPM) but without any reference to heart anatomy failed to show improvement in CRT response when using BSPM to guide LV lead placement and programming. 12 …”

Section: Introductionmentioning

confidence: 99%

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

et al. 2023

Self Cite

View full text Add to dashboard Cite

show abstract

“… 26 Other methods to assess electrical dyssynchrony have been investigated, including the body surface mapping and ECG belts. 36 , 37 The ‘Electrocardiogram Belt Guidance for Left Ventricular Lead Placement and Biventricular Pacing Optimization’ (ECG Belt Trial) was a multicentre RCT with 408 patients comparing the ECG Belt System (EBS)-guided LV lead implantation or routine CRT care, showing no added value of targeted positioning. 36 The EBS is a surface mapping system designed to measure electrical dyssynchrony of the LV, and not to specifically target the latest electrical activated region.…”

Section: Discussionmentioning

confidence: 99%

“… 36 , 37 The ‘Electrocardiogram Belt Guidance for Left Ventricular Lead Placement and Biventricular Pacing Optimization’ (ECG Belt Trial) was a multicentre RCT with 408 patients comparing the ECG Belt System (EBS)-guided LV lead implantation or routine CRT care, showing no added value of targeted positioning. 36 The EBS is a surface mapping system designed to measure electrical dyssynchrony of the LV, and not to specifically target the latest electrical activated region. Another recent study evaluated the impact of atrioventricular (AV) timing algorithms using non-invasive epicardial electrocardiographic imaging (ECGi).…”

Section: Discussionmentioning

confidence: 99%

Targeted left ventricular lead positioning to the site of latest activation in cardiac resynchronization therapy: a systematic review and meta-analysis

Fyenbo,

Bjerre,

Frausing

et al. 2023

Europace

View full text Add to dashboard Cite

Aims Several studies have evaluated the use of electrically- or imaging-guided left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) recipients. We aimed to assess evidence for a guided strategy that targets LV lead position to the site of latest LV activation. Methods and results A systematic review and meta-analysis was performed for randomized controlled trials (RCTs) until March 2023 that evaluated electrically- or imaging-guided LV lead positioning on clinical and echocardiographic outcomes. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization, and secondary endpoints were quality of life, 6-min walk test (6MWT), QRS duration, LV end-systolic volume, and LV ejection fraction. We included eight RCTs that comprised 1323 patients. Six RCTs compared guided strategy (n = 638) to routine (n = 468), and two RCTs compared different guiding strategies head-to-head: electrically- (n = 111) vs. imaging-guided (n = 106). Compared to routine, a guided strategy did not significantly reduce the risk of the primary endpoint after 12–24 (RR 0.83, 95% CI 0.52–1.33) months. A guided strategy was associated with slight improvement in 6MWT distance after 6 months of follow-up of absolute 18 (95% CI 6–30) m between groups, but not in remaining secondary endpoints. None of the secondary endpoints differed between the guided strategies. Conclusion In this study, a CRT implantation strategy that targets the latest LV activation did not improve survival or reduce heart failure hospitalizations.

show abstract

“…Over the past decade, various alternative methods of ventricular dyssynchrony assessment have been proposed. These range from simple options such as vectorcardiography [ 9 , 10 , 11 ] and ultra-high-frequency ECG (UHF-ECG) to more advanced techniques like ECG-belt [ 12 , 13 , 14 , 15 ], ECG-imaging [ 16 , 17 , 18 , 19 , 20 , 21 ] and electro-anatomic mapping [ 6 , 22 , 23 , 24 , 25 , 26 ] ( Figure 1 ).…”

Section: Introductionmentioning

confidence: 99%

Ultra-High-Frequency ECG in Cardiac Pacing and Cardiac Resynchronization Therapy: From Technical Concept to Clinical Application

Nguyên,

Rijks,

Plesinger

et al. 2024

JCDD

Self Cite

View full text Add to dashboard Cite

Identifying electrical dyssynchrony is crucial for cardiac pacing and cardiac resynchronization therapy (CRT). The ultra-high-frequency electrocardiography (UHF-ECG) technique allows instantaneous dyssynchrony analyses with real-time visualization. This review explores the physiological background of higher frequencies in ventricular conduction and the translational evolution of UHF-ECG in cardiac pacing and CRT. Although high-frequency components were studied half a century ago, their exploration in the dyssynchrony context is rare. UHF-ECG records ECG signals from eight precordial leads over multiple beats in time. After initial conceptual studies, the implementation of an instant visualization of ventricular activation led to clinical implementation with minimal patient burden. UHF-ECG aids patient selection in biventricular CRT and evaluates ventricular activation during various forms of conduction system pacing (CSP). UHF-ECG ventricular electrical dyssynchrony has been associated with clinical outcomes in a large retrospective CRT cohort and has been used to study the electrophysiological differences between CSP methods, including His bundle pacing, left bundle branch (area) pacing, left ventricular septal pacing and conventional biventricular pacing. UHF-ECG can potentially be used to determine a tailored resynchronization approach (CRT through biventricular pacing or CSP) based on the electrical substrate (true LBBB vs. non-specified intraventricular conduction delay with more distal left ventricular conduction disease), for the optimization of CRT and holds promise beyond CRT for the risk stratification of ventricular arrhythmias.

show abstract

Electrocardiogram Belt guidance for left ventricular lead placement and biventricular pacing optimization

Cited by 10 publications

References 27 publications

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

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

Targeted left ventricular lead positioning to the site of latest activation in cardiac resynchronization therapy: a systematic review and meta-analysis

Ultra-High-Frequency ECG in Cardiac Pacing and Cardiac Resynchronization Therapy: From Technical Concept to Clinical Application

Contact Info

Product

Resources

About