Three-Dimensional Cardiac Mapping Characterizes Ventricular Contractile Patterns during Cardiac Resynchronization Therapy Implant: A Feasibility Study

• Published in: Pacing and clinical electrophysiology Vol. 38; no. 9; pp. 1091 - 1098
• Main Authors: NIAZI, IMRAN K., SPERZEL, JOHANNES, HEIST, EDWIN KEVIN, ROSENBERG, STUART P., RYU, KYUNGMOO, YANG, MICHAEL, D'AVILA, ANDRE, SINGH, JAGMEET P.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.09.2015
• Subjects: Aged; Body Surface Potential Mapping - methods; cardiac resynchronization therapy; Cardiac Resynchronization Therapy Devices; contractility; dyssynchrony; electroanatomic mapping; Feasibility Studies; Female; heart failure; Heart Failure - complications; Heart Failure - diagnosis; Heart Failure - prevention & control; Humans; Male; Middle Aged; Prosthesis Implantation - methods; Reproducibility of Results; Sensitivity and Specificity; Surgery, Computer-Assisted - methods; Treatment Outcome; Ventricular Dysfunction, Left - diagnosis; Ventricular Dysfunction, Left - etiology; Ventricular Dysfunction, Left - prevention & control; heart failure; electroanatomic mapping; dyssynchrony; cardiac resynchronization therapy; contractility
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.12674

Background Electroanatomic mapping systems track the position of electrodes in the heart. We assessed the feasibility of characterizing left ventricular (LV) performance during cardiac resynchronization therapy (CRT) implant utilizing an electroanatomic mapping system to track the motion of CRT lead electrodes, thus deriving ventricular contractility surrogates. Methods During CRT implant, atrial, right ventricular (RV), and LV leads were connected to the EnSite NavX™ mapping system (St. Jude Medical Inc., St. Paul, MN, USA). The relative displacement of electrodes was averaged over 10 cardiac cycles during RV, LV, and biventricular (BiV) pacing in DOO mode. Three contractility surrogates indicative of ventricular performance were extracted from the RV‐LV distance waveform: systolic slope (SS), time to peak systolic contraction (TPSC), and fractional shortening (FS). Results In the 20 patients included, there were detectable differences in each of the three contractility surrogates responding to the different pacing configurations. Median SS varied 42%, median TPSC varied 35%, and median FS varied 19% across RV, LV, and BiV pacing interventions. The RV‐LV distance waveform showed subtle sensitivity to varying pacing timing cycles when measured in a subset of patients. For all pacing configurations, RV‐LV distance waveforms were stable during 2‐minute recordings. Conclusions Tracking the motion of CRT pacing electrodes with a mapping system to derive contractility surrogates during implant is feasible.