Sieniewicz Benjamin J, Jackson Tom, Claridge Simon, Pereira Helder, Gould Justin, Sidhu Baldeep, Porter Bradley, Niederer Steve, Yao Cheng, Rinaldi Christopher A
Division of Imaging Sciences and Biomedical Engineering King's College London London UK.
Cardiology Department Guys and St Thomas' NHS Foundation Trust London UK.
J Arrhythm. 2019 Jan 14;35(2):267-275. doi: 10.1002/joa3.12153. eCollection 2019 Apr.
Quadripolar lead technology and multi-point pacing (MPP) are important clinical adjuncts in cardiac resynchronization therapy (CRT) pacing aimed at reducing the rate of non-response to therapy. Mixed results have been achieved using MPP and it is critical to identify which patients require this approach and how to configure their MPP stimulation, in order to achieve optimal electrical resynchronization.
METHODS & RESULTS: We sought to investigate whether electrocardiographic imaging (ECGi), using the CARDIOINSIGHT inverse ECG mapping system, could identify alterations in electrical resynchronization during different methods of device optimization. In no patient did a single form of programming optimization provide the best electrical response. The effects of utilizing MPP were idiosyncratic and highly patient specific. ECGi activation maps were clearly able to discern changes in bulk LV activation during differing MPP programming. In two of the five subjects, MPP resulted in more rapid activation of the left ventricle compared to standard CRT; however, in the remaining three patients, the use of MPP did not appear to acutely improve electrical resynchronization. Crucially, this cohort showed evidence of extensive LV scarring which was well visualized using both CMR and ECGi voltage mapping.
Our work suggests a potential role for ECGi in the optimization of non-responders to CRT, as it allows the fusion of activation maps and scar analysis above and beyond interrogation of the 12 lead ECG.
四极导线技术和多点起搏（MPP）是心脏再同步治疗（CRT）起搏中的重要临床辅助手段，旨在降低治疗无反应率。使用MPP取得了混合结果，确定哪些患者需要这种方法以及如何配置他们的MPP刺激以实现最佳电再同步至关重要。
我们试图研究使用CARDIOINSIGHT逆向心电图映射系统的心电图成像（ECGi）是否能在不同的设备优化方法期间识别电再同步的改变。没有一位患者通过单一形式的编程优化获得最佳电反应。使用MPP的效果因人而异且高度个体化。ECGi激活图能够清晰地辨别不同MPP编程期间左心室整体激活的变化。在五名受试者中的两名中，与标准CRT相比，MPP导致左心室激活更快；然而，在其余三名患者中，使用MPP似乎并未急性改善电再同步。至关重要的是，该队列显示出广泛左心室瘢痕的证据，使用心脏磁共振成像（CMR）和ECGi电压映射均可很好地显示。
我们的工作表明ECGi在优化CRT无反应者方面具有潜在作用，因为它允许融合激活图和瘢痕分析，超越了对12导联心电图的检查。
