The HF-CGM Study: An Analysis of Cardiogoniometric Axes in Patients With Cardiac Resynchronization Therapy
Insights
Cardiogoniometry (CGM) can distinguish between different pacing modes in cardiac resynchronization therapy (CRT) patients. The XY plane of CGM effectively identifies pacing sites and may predict optimal CRT response.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Cardiac resynchronization therapy (CRT) is crucial for heart failure management.
- Differentiating pacing modes is essential for optimizing CRT efficacy.
- Current methods for assessing pacing effectiveness can be limited.
Purpose of the Study:
- To evaluate cardiogoniometry (CGM) as a tool to differentiate between various pacing modes in CRT patients.
- To determine if CGM can identify optimal CRT response based on pacing parameters.
Main Methods:
- CGM recordings were obtained in 22 CRT patients under four pacing conditions: no pacing, RV, LV, and biventricular (BIV) pacing.
- Three orthogonal CGM planes (XY, YZ, XZ) were analyzed to calculate the QRS-axis direction.
- QRS-axis direction in the XY plane was compared between optimal and non-optimal pacing configurations during BIV pacing.
Main Results:
- The QRS-axis in the XY plane of CGM significantly differentiated between all pacing modes and no pacing.
- Distinct QRS-axis patterns were observed for RV (leftward/basal), LV (apical), and BIV (rightward/basal) pacing.
- A significant difference in XY plane QRS-axis direction was found between optimal and non-optimal BIV pacing.
Conclusions:
- CGM, particularly in the XY plane, accurately detects differences in ventricular pacing sites.
- CGM shows potential for identifying CRT patients with an optimal response in situ.
Goal:
The HF-CGM is a proof-of-principle study to investigate whether cardiogoniometry (CGM), a three-dimensional electrocardiographic method, can differentiate between pacing modes in patients with cardiac resynchronization therapy (CRT).
Methods:
At a tertiary cardiology center, CGM recordings were performed using four pacing modes: no pacing; right ventricular (RV) pacing; left ventricular (LV) pacing, and biventricular (BIV) pacing. Three orthogonal CGM planes orientated to the long axis (XY), the frontal plane (YZ), and the short axis (XZ) of the heart were constructed, and the direction of the QRS-axis was calculated for each pacing mode in each plane. During BIV pacing, the direction of CGM QRS-axis was compared between patients with optimal and nonoptimal 12-lead pacing variables.
Results:
Twenty-two participants (aged 71.5 ± 10.8; 77.3% male, LVEF 29 ± 7%) were consecutively recruited. Only QRS-axis measured in the XY plane could significantly distinguish between all three pacing modes versus no pacing. Mean QRS-axis in the XY plane with pacing off and during RV pacing was leftward and basal; LV pacing was apical; and BIV pacing was rightward and basal. There was a statistically significant difference in the direction of the QRS-axis between patients with optimal versus nonoptimal paced QRS morphology in the XY plane (rightward and basal versus inconsistent).
Significance:
CGM recorded in the XY plane can accurately detect differences between ventricular pacing sites. It may also be able to identify patients with a CRT device in situ who have optimal response.
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