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Updated: Aug 8, 2025
Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
Non-invasive three-dimensional electrical activation mapping to predict cardiac resynchronization therapy response:
Leonor Parreira1, Alexey Tsyganov2,3, Elena Artyukhina4
1Department of Electrophysiology, Hospital da Luz, S.A., Lisbon, Portugal.
Insights
Optimizing cardiac resynchronization therapy (CRT) response depends on left ventricular (LV) pacing site proximity to the latest electrical activation site. Non-invasive electrical mapping can guide LV lead placement for improved CRT outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Imaging
Background:
- Cardiac resynchronization therapy (CRT) efficacy can be limited by suboptimal left ventricular (LV) pacing site selection.
- Pacing distant from the latest electrically activated site (LEAS) may reduce CRT response rates.
Purpose of the Study:
- To investigate whether the proximity of the LV pacing site (LVPS) to the LEAS, identified by electrocardiographic Imaging (ECGI), influences CRT response.
- To determine if non-invasive electrical mapping can predict CRT success.
Main Methods:
- 111 CRT patients underwent ECGI and CT scans post-implant.
- The distance (dp) between LVPS and LEAS was assessed.
- Logistic regression analyzed predictors of non-response, including dp and CRT optimization algorithm use.
Main Results:
- 67% of patients responded to CRT, defined by ≥15% LV end-systolic volume reduction.
- The distance (dp) was significantly greater in non-responders (63 ± 24 mm) compared to responders (31 ± 14 mm).
- Longer dp and lack of CRT optimization algorithm were independent predictors of non-response (AUC 0.906).
Conclusions:
- The distance between LV pacing site and LEAS is a strong predictor of CRT response.
- Non-invasive electrical evaluation can guide LV lead deployment to enhance CRT efficacy.
Aims:
Pacing remote from the latest electrically activated site (LEAS) in the left ventricle (LV) may diminish response to cardiac resynchronization therapy (CRT). We tested whether proximity of LV pacing site (LVPS) to LEAS, determined by non-invasive three-dimensional electrical activation mapping [electrocardiographic Imaging (ECGI)], increased likelihood of CRT response.
Methods And Results:
Consecutive CRT patients underwent ECGI and chest/heart computed tomography 6-24 months of post-implant. Latest electrically activated site and the distance to LVPS (dp) were assessed. Left ventricular end-systolic volume (LVESV) reduction of ≥15% at clinical follow-up defined response. Logistic regression probabilistically modelled non-response; variables included demographics, heart failure classification, left bundle branch block (LBBB), ischaemic heart disease (IHD), atrial fibrillation, QRS duration, baseline ejection fraction (EF) and LVESV, comorbidities, use of CRT optimization algorithm, angiotensin-converting enzyme inhibitor(ACE)/angiotensin-receptor blocker (ARB), beta-blocker, diuretics, and dp. Of 111 studied patients [64 ± 11 years, EF 28 ± 6%, implant duration 12 ± 5 months (mean ± SD), 98% had LBBB, 38% IHD], 67% responded at 10 ± 3 months post CRT-implant. Latest electrically activated sites were outside the mid-to-basal lateral segments in 35% of the patients. dp was 42 ± 23 mm [31 ± 14 mm for responders vs. 63 ± 24 mm non-responders (P < 0.001)]. Longer dp and the lack of use of CRT optimization algorithm were the only independent predictors of non-response [area under the curve (AUC) 0.906]. dp of 47 mm delineated responders and non-responders (AUC 0.931).
Conclusion:
The distance between LV pacing site and latest electrical activation is a strong independent predictor for CRT response. Non-invasive electrical evaluation to characterize intrinsic activation and guide LV lead deployment may improve CRT efficacy.
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