Analysis of lead placement optimization metrics in cardiac resynchronization therapy with computational modelling

Area of Science:

• Cardiovascular research
• Biomedical engineering
• Computational modeling

Background:

• Cardiac resynchronization therapy (CRT) efficacy varies with pacing location.
• Optimal pacing site selection metrics for CRT are not well understood.
• Computational modeling can simulate and optimize CRT pacing in silico.

Purpose of the Study:

• To perform an in silico left ventricle (LV) pacing site optimization study for biventricular CRT.
• To assess clinically available metrics for selecting optimal CRT pacing sites.
• To investigate the relationship between pacing location and therapeutic response.

Main Methods:

• Personalized computational models of cardiac electromechanics were used.
• In silico left ventricle (LV) pacing site optimization was performed for three patients.
• Response to therapy was mapped using changes in total activation time (ΔTAT) and acute hemodynamic response (AHR).
• Preclinical metrics including electrical function, strain, stress, and mechanical work were compared.

Main Results:

• Therapeutic response was highly sensitive to pacing location, with laterobasal sites being optimal.
• ΔTAT and AHR were strongly correlated (ρ < -0.80).
• AHR was also correlated with preclinical activation time at the pacing site (ρ ≥ 0.73).
• Pacing the last activated site did not consistently yield optimal results.

Conclusions:

• Laterobasal pacing locations are supported for CRT.
• Minimizing paced QRS duration is a promising metric for optimizing CRT lead placement.
• Preclinical metrics showed redundant information content; ΔTAT and AHR correlation supports QRSd minimization.