Abstract 15981: Detailed Assessment of Biventricular Pacing Effects Utilizing Non-Invasive Electrical Activation Mapping
Purpose: Identification of proper candidates for cardiac resynchronization therapy (CRT) remains challenging. Currently used selection tools and optimization strategies are associated with a 30% non-response rate. Therefore, a novel non-invasive electrical activation mapping technique was applied in CRT candidates. This study was conducted to determine whether this technique could accurately identify lead position and left ventricular (LV) pacing offset in CRT patients.
Methods: In 8 patients, a patient specific 3D volume conductor model was reconstructed from MRI images. Body surface potentials were recorded from 65 torso electrodes before and after implantation of a biventricular pacing device. During the post-implant recording, LV pacing offset was varied with 10ms intervals. Ventricular activation maps were computed for each offset, using the fastest route based activation imaging method.
Results: In all patients lead positions were correctly identified. Variations in ventricular activation sequence, due to various pacing offsets, were detected with a temporal resolution of 10ms (figure 1B+C).
Conclusion: Non-invasive ventricular activation mapping correctly identified left and right lead positions in CRT patients. The complete ventricular activation sequence was visualized during various pacing offsets. This technique offers the prospect to improve selection of CRT candidates, guidance of lead positioning and may be of advantage for CRT optimization. Figure 1: Left panel (A): Ventricular activation map during LV pacing merged with a fluoroscopic recording in LAO view. The site of earliest activation (pink) corresponds with the position of the LV lead. Right panel: Ventricular activation maps during programmed LV offset of 50ms (B), 40ms (C), RV pacing (D) and simultaneous pacing (E). Activation time in milliseconds.
- © 2012 by American Heart Association, Inc.