A novel approach for left ventricular lead placement in cardiac resynchronization therapy: Intraprocedural integration of coronary venous electroanatomic mapping with delayed enhancement cardiac magnetic resonance imaging

Nguyên, Uyên Châu; Mafi-Rad, Masih; Aben, Jean-Paul; Smulders, Martijn W.; Engels, Elien B.; Stipdonk, Antonius M.W. van; Luermans, Justin; Bekkers, Sebastiaan C.A.M.; Prinzen, Frits W.; Vernooy, Kevin

doi:10.1016/j.hrthm.2016.09.015

Cited by 34 publications

(27 citation statements)

References 16 publications

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“…One potential method would be integration of CMR imaging data into the EAM system. 25 Alternative novel approaches for more accurate invasive scar delineation include the use of impedance measurements 24 and the wavefront-independent omnipolar electrograms. 26,27…”

Section: Discussionmentioning

confidence: 99%

A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: anin vivoandin silicostudy

et al. 2018

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Aims he aim of this study was to investigate the influence of the activation sequence on voltage amplitudes by evaluating regional voltage differences during a left bundle branch block (LBBB) activation sequence vs. a normal synchronous activation sequence and by evaluating pacing-induced voltage differences. Methods and results wenty-one patients and three computer models without scar were studied. Regional voltage amplitudes were evaluated in nine LBBB patients who underwent endocardial electro-anatomic mapping (EAM). Pacing-induced voltage differences were evaluated in 12 patients who underwent epicardial EAM during intrinsic rhythm and right ventricular (RV) pacing. Three computer models customized for LBBB patients were created. Changes in voltage amplitudes after an LBBB (intrinsic), a normal synchronous, an RV pacing, and a left ventricular pacing activation sequence were assessed in the computer models. Unipolar voltage amplitudes in patients were approximately 4.5 mV (4.4-4.7 mV, 33%) lower in the septum when compared with other segments. A normal synchronous activation sequence in the computer models normalized voltage amplitudes in the septum. Pacinginduced differences were larger in electrograms with higher voltage amplitudes during intrinsic rhythm and furthermore larger and more variable at the epicardium [mean absolute difference: 3.6-6.2 mV, 40-53% of intrinsic value; interquartile range (IQR) differences: 53-63% of intrinsic value] compared to the endocardium (mean absolute difference: 3.3-3.8 mV, 28-30% of intrinsic value; IQR differences: 37-40% of intrinsic value). Conclusion In patients and computer models without scar, lower septal unipolar voltage amplitudes are exclusively associated with an LBBB activation sequence. Pacing substantially affects voltage amplitudes, particularly at the epicardium.

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Section: Discussionmentioning

confidence: 99%

A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: anin vivoandin silicostudy

et al. 2018

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“…We sample from the uncertainty distribution of each of the 4 anatomies depicted in figure 2. We assumed the fol- As the typical discrepancy between anatomies obtained with EAM and anatomies obtained with MRI scan is 5mm [7], in this work we considered the following characteristic values: ν 2 = [25, 49, 100, 225, 784] mm 2 , while we arbitrarily chose a width l equal to 10 mm.…”

Section: Resultsmentioning

confidence: 99%

An Algorithm to Sample an Anatomy With Uncertainty

Corrado

Williams

Sim

et al. 2018

2018 Computing in Cardiology Conference (CinC)

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“…Patient-specific models were used to predict the electrical activation of the heart, with the conduction velocity fitted to the QRS duration for 14 patients. Delayed enhancement cardiac MRI was used to personalize the geometry and delineation of scar [9]. Intra-procedural coronary venous electro-anatomical mapping was performed during right ventricular pacing and the clinical measurements were used to identify the relative importance of scar, anterior or posterior functional block, slow septal conduction and fast endocardial conduction.…”

Section: Methodsmentioning

confidence: 99%

Predicting Activation Patterns in Cardiac Resynchronization Therapy Patients

Lee

Nguyên

Gould

et al. 2018

2018 Computing in Cardiology Conference (CinC)

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Cardiac resynchronization therapy (CRT) is an effective treatment for heart failure patients. Suboptimal pacing timings and locations have been identified as causes for nonresponse to CRT. Patient specific computer models allow for the prediction of the electrical activation pattern on the ventricles, which can then be used to optimise CRT lead location. The electrical activation of the heart depends on the underlying cardiac substrate. The electrical properties of the heart have been found to be heterogeneous, with scar, functional block, septal slowing, and fast endocardial conduction impacting the electrical activation across the ventricles. Non-invasive data from 14 patients were used to create computer models of the heart. The patient specific models were then used to assess the importance of the heterogeneous cardiac substrates on accurately predicting the electrical activation pattern of the ventricles. Fast endocardial conduction was found to be the most important factor in accurately predicting the electrical activation of the heart in CRT patients.

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A novel approach for left ventricular lead placement in cardiac resynchronization therapy: Intraprocedural integration of coronary venous electroanatomic mapping with delayed enhancement cardiac magnetic resonance imaging

Cited by 34 publications

References 16 publications

A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: anin vivoandin silicostudy

A left bundle branch block activation sequence and ventricular pacing influence voltage amplitudes: anin vivoandin silicostudy

An Algorithm to Sample an Anatomy With Uncertainty

Predicting Activation Patterns in Cardiac Resynchronization Therapy Patients

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