Electrical Substrates Driving Response to Cardiac Resynchronization Therapy: A Combined Clinical-Computational
Peter R Huntjens1, Sylvain Ploux2, Marc Strik2
1Electrophysiology and Heart Modeling Institute (LIRYC), Bordeaux University, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiac Electrophysiology and Cardiac Stimulation Team, Bordeaux University Hospital, Pessac, France (P.R.H., S.P., M.S., P.R., M.H., J.L., P.B.). Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, the Netherlands (P.R.H., M.S., J.W., F.W.P., T.D., J.L.). p.huntjens@maastrichtuniversity.nl.
Circulation. Arrhythmia and Electrophysiology
|April 15, 2018
Summary
Interventricular dyssynchrony, not intraventricular, is key for predicting cardiac resynchronization therapy (CRT) response. This finding aids in developing patient-specific CRT predictive models for better outcomes.
Area of Science:
- Cardiology
- Biomedical Engineering
- Computational Biology
Background:
- The predictive value of interventricular versus intraventricular dyssynchrony for cardiac resynchronization therapy (CRT) response is not well understood.
- Left ventricular (LV) hemodynamic function is influenced by both interventricular and intraventricular electrical activation patterns.
Purpose of the Study:
- To investigate the relative importance of interventricular and intraventricular dyssynchrony in predicting CRT response.
- To assess the role of electrical substrate components in determining LV hemodynamic function.
Main Methods:
- Utilized the CircAdapt cardiovascular computational model to simulate the isolated effects of intrinsic interventricular and intraventricular activation on CRT response.
- Personalized ventricular activation in CircAdapt using electrocardiographic imaging-derived data from 51 CRT candidates.
- Assessed the accuracy of predicting CRT response (ΔLVdP/dtmax) using personalized computational models.
Main Results:
- Increased interventricular dyssynchrony significantly improved simulated CRT response (ΔLVdP/dtmax range: 1.3%-26.5%).
- Isolated intraventricular dyssynchrony had a limited effect on CRT response (ΔLVdP/dtmax range: 12.3%-18.3%).
- Personalized models accurately predicted CRT response in patients with left bundle branch block when only interventricular dyssynchrony was considered; however, response was overpredicted in patients without left bundle branch block. Adding intraventricular dyssynchrony did not improve prediction accuracy.
Conclusions:
- Intrinsic interventricular dyssynchrony is the primary electrical substrate component driving CRT response.
- Intrinsic intraventricular dyssynchrony and biventricular pacing-induced dyssynchrony play minor roles in CRT response.
- These findings support the development of patient-specific models for predicting CRT response, focusing on interventricular dyssynchrony.
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