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Guidewire Method for Measuring Local Left Ventricular Electrical Activation Time During Cardiac Resynchronization
Seth J Rials1, Michele Pershing2, Christy Collins2
1OhioHealth Heart and Vascular Physicians, Division of Cardiology, Grant Medical Center, Columbus, OH, USA.
Summary
A novel guidewire accurately measures left ventricular (LV) activation timing (QLV) before permanent lead placement. This method simplifies cardiac resynchronization therapy (CRT) lead selection without electroanatomic mapping.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Devices
Background:
- Accurate left ventricular (LV) activation timing (QLV) is crucial for successful cardiac resynchronization therapy (CRT).
- Traditional QLV measurement relies on permanent pacing leads or complex electroanatomic mapping systems.
- Identifying sites of late LV activation improves CRT response rates.
Purpose of the Study:
- To compare QLV measurements obtained using a novel guidewire versus permanent LV pacing leads.
- To evaluate the feasibility of using a guidewire for prospective LV activation mapping during CRT implantation.
- To determine if a guidewire can replace electroanatomic mapping for QLV assessment.
Main Methods:
- Prospective study involving 20 patients undergoing CRT implantation.
- QLV measurements were taken using a guidewire at potential LV pacing sites.
- Measurements were repeated after positioning the permanent LV pacing lead at the identical site.
- No electroanatomic mapping systems were used.
Main Results:
- No significant difference was found between guidewire and permanent lead QLV measurements (p = 0.569).
- Guidewire and permanent lead QLV measurements demonstrated strong correlation (r = 0.965; p < 0.001).
- Median absolute difference in electrogram duration was 7.0 ms (p = 0.55).
- Average guidewire measurement time was 11.7 minutes, comparable to total procedure fluoroscopy time (10.9 minutes).
Conclusions:
- A guidewire provides accurate and reliable QLV measurements comparable to permanent leads.
- This guidewire method offers a simplified approach for LV activation mapping during CRT procedures.
- Prospective LV activation assessment with a guidewire can be performed without electroanatomic mapping systems, potentially streamlining lead selection.
