Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal.
I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
Europace. 2023 Apr 15;25(4):1458-1466. doi: 10.1093/europace/euad041.
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.
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).
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.
在左心室（LV）中起搏远离最新电激活部位（LEAS）可能会降低心脏再同步治疗（CRT）的反应。我们测试了 LV 起搏部位（LVPS）与 LEAS 的接近程度，通过非侵入性三维电激活映射[心电图成像（ECGI）]来确定，是否增加了 CRT 反应的可能性。
连续的 CRT 患者在植入后 6-24 个月接受了 ECGI 和胸部/心脏计算机断层扫描。评估了最新的电激活部位和与 LVPS 的距离（dp）。临床随访时左心室收缩末期容积（LVESV）减少≥15%定义为反应。逻辑回归概率模型预测无反应；变量包括人口统计学、心力衰竭分类、左束支传导阻滞（LBBB）、缺血性心脏病（IHD）、心房颤动、QRS 持续时间、基线射血分数（EF）和 LVESV、合并症、使用 CRT 优化算法、血管紧张素转换酶抑制剂（ACE）/血管紧张素受体阻滞剂（ARB）、β受体阻滞剂、利尿剂和 dp。在 111 例研究患者中[64±11 岁，EF 28±6%，植入持续时间 12±5 个月（平均值±标准差），98%为 LBBB，38%为 IHD]，98%在 CRT 植入后 10±3 个月时出现反应。在 35%的患者中，最新的电激活部位位于中-基底外侧段之外。dp 为 42±23mm[31±14mm 为反应者，63±24mm 为无反应者（P<0.001）]。较长的 dp 和未使用 CRT 优化算法是无反应的唯一独立预测因素[曲线下面积（AUC）0.906]。dp 为 47mm 可区分反应者和无反应者（AUC 0.931）。
LV 起搏部位与最新电激活之间的距离是 CRT 反应的一个强有力的独立预测因子。非侵入性电评估来描述固有激活并指导 LV 导联的放置可能会提高 CRT 的疗效。
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