Quest for the ideal assessment of electrical ventricular dyssynchrony in cardiac resynchronization therapy

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Imaging

Background:

• Current electrocardiogram (ECG) criteria for cardiac resynchronization therapy (CRT), including QRS duration and left bundle branch block (LBBB) morphology, have limitations.
• Despite limitations, these ECG criteria remain the guideline-recommended approach for patient selection in large CRT trials.

Purpose of the Study:

• To review the literature on alternative methods for assessing electrical dyssynchrony in patients undergoing CRT.
• To explore novel techniques beyond traditional ECG measures for optimizing CRT patient selection and strategy.

Main Methods:

• Literature review of various electrical dyssynchrony assessment techniques.
• Discussion of methods including vectorcardiography (VCG), ultra-high frequency ECG, electrical dyssynchrony mapping, and ECG imaging electro-anatomic mapping.
• Exploration of the potential of conduction system pacing, artificial intelligence, and computer modeling in CRT.

Main Results:

• Several alternative dyssynchrony measures have been proposed, showing promising results in research settings.
• Vectorcardiography (VCG) is highlighted as a cost-effective option for potential clinical use, reconstructible from standard 12-lead ECG.
• No single alternative method has achieved widespread clinical adoption to date.

Conclusions:

• Electrical dyssynchrony assessment is crucial for patient selection and optimizing CRT strategies, especially with emerging pacing techniques.
• Advanced techniques and artificial intelligence hold potential for uncovering new insights into CRT mechanisms and outcomes.
• Further research and validation are needed for wider clinical implementation of novel dyssynchrony assessment methods.