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Optimal pacing sites in cardiac resynchronization by left ventricular activation front analysis
Mohammad Albatat1, Hermenegild Arevalo2, Jacob Bergsland3
1Intervention Centre, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Insights
This study introduces a new computational method to predict optimal cardiac resynchronization therapy (CRT) lead placement. The maximum activation front (MAF) analysis helps identify better pacing sites for heart failure patients, improving CRT effectiveness.
Area of Science:
- Computational modeling
- Cardiac electrophysiology
- Heart failure treatment
Background:
- Cardiac resynchronization therapy (CRT) improves heart failure outcomes but lacks efficacy in ~30% of patients.
- Suboptimal left ventricular (LV) activation due to electrical heterogeneity contributes to CRT non-response.
- Predicting optimal pacing sites remains a clinical challenge.
Purpose of the Study:
- To evaluate a novel computational method for analyzing electrical wavefront propagation.
- To assess the performance of the maximum activation front (MAF) method in predicting optimal CRT pacing sites.
- To compare simulation results with clinical data for validation.
Main Methods:
- Developed computational heart models based on patient-specific cardiac MR images, including myocardial scar.
- Simulated electrical propagation and calculated MAF in the LV under various pacing scenarios (RV apex, 12 LV sites, multi-site).
- Compared MAF-derived optimal pacing sites with clinical benchmarks and latest activated regions.
Main Results:
- For single LV pacing, the site with the largest MAF accurately identified regions of latest activation during right ventricular (RV) pacing.
- The MAF method successfully predicted optimal electrode placements in complex models with scar tissue.
- Demonstrated utility in multi-site LV pacing scenarios.
Conclusions:
- The MAF analysis is a promising computational tool for understanding electrical propagation in the heart.
- This method shows potential for improving the prediction of optimal lead placement in CRT.
- Computational simulations can aid in personalized CRT planning and enhance patient outcomes.
Abstract:
Cardiac resynchronization therapy (CRT) can substantially improve dyssynchronous heart failure and reduce mortality. However, about one-third of patients who are implanted, derive no measurable benefit from CRT. Non-response may partly be due to suboptimal activation of the left ventricle (LV) caused by electrophysiological heterogeneities. The goal of this study is to investigate the performance of a newly developed method used to analyze electrical wavefront propagation in a heart model including myocardial scar and compare this to clinical benchmark studies. We used computational models to measure the maximum activation front (MAF) in the LV during different pacing scenarios. Different heart geometries and scars were created based on cardiac MR images of three patients. The right ventricle (RV) was paced from the apex and the LV was paced from 12 different sites, single site, dual-site and triple site. Our results showed that for single LV site pacing, the pacing site with the largest MAF corresponded with the latest activated regions of the LV demonstrated during RV pacing, which also agrees with previous markers used for predicting optimal single-site pacing location. We then demonstrated the utility of MAF in predicting optimal electrode placements in more complex scenarios including scar and multi-site LV pacing. This study demonstrates the potential value of computational simulations in understanding and planning CRT.
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