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A Novel High-Resolution Surface Electrocardiographic Method to Identify and Characterize Myocardial Scar: A
Derek S Chew1,2, Sharita Manga1, Andrew Roberts1
1Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
CJC Open
|December 10, 2021
Summary
The novel ECG Amplitude Signal Evaluation (EASE) method accurately identifies left ventricular (LV) scar during cardiac resynchronization therapy implantation. Pacing in scarred regions showed a significant reduction in LV pacing stimulus amplitude on surface ECG.
Area of Science:
- Cardiology
- Medical Devices
- Diagnostic Tools
Background:
- Optimal left ventricular (LV) lead placement is crucial for cardiac resynchronization therapy (CRT) response.
- Myocardial scar impedes CRT efficacy, necessitating intraoperative identification.
- Current methods for scar assessment may be limited during CRT procedures.
Purpose of the Study:
- To develop and validate a novel electrocardiogram (ECG)-based method for intraoperative LV scar identification.
- To test the hypothesis that LV pacing in scar tissue results in reduced pacing stimulus amplitude on surface ECG.
- To introduce the ECG Amplitude Signal Evaluation (EASE) method for guiding LV lead placement.
Main Methods:
- Prospective enrollment of patients with ischemic LV systolic dysfunction undergoing CRT.
- Pre-implant contrast-enhanced cardiac magnetic resonance (CMR) to quantify myocardial scar.
- Intraoperative sampling of LV pacing impulse amplitude using high-resolution (HR) surface ECG.
- Comparison of ECG-measured amplitudes with CMR-identified scar regions.
Main Results:
- 38 LV pacing sites in 13 patients were analyzed.
- A significant 41% median reduction in surface ECG voltage was observed when pacing in scar regions (p < 0.0001).
- No significant voltage change occurred when pacing in scar-free regions.
Conclusions:
- The EASE method shows potential as a practical intraoperative tool for guiding LV lead placement away from scar.
- This ECG-based technique may improve CRT outcomes by optimizing lead positioning.
- Further validation in larger patient cohorts is warranted to confirm the utility of the EASE method.
