Cardiac Resynchronization Guided by Ultra-High-Frequency ECG Maps

Abstract

Here we present a technique based on 14-lead ultrahigh-frequency electrocardiogram (UHF-ECG, 5 kHz) able to measure the immediate effect of cardiac resynchronization therapy (CRT) settings on electrical ventricular dyssynchrony.Resting UHF-ECGs were sequentially recorded during different CRT settings: CRT OFF, CRT ON, VV delays 0, -20, -40 ms, and SMART sensing (Boston Scientific) in 33 patients. Electrical depolarization maps were computed from signal-averaged UHF-ECGs in the frequency band 150-1000 Hz. The horizontal axis of each map indicates time and the vertical axis indicates the activation location (V1-V8 lead). The red areas show the location-time of the maximal volume of simultaneously depolarized myocardial cells.The optimal CRT setting is characterized by a narrow and vertical activation pattern. Optimal CRT setting selected by a physician from electrical depolarization maps corresponded to the minimal mechanical intraventricular delay obtained from echocardiography in 61% of patients; in 27% of patients the difference was within a 10 ms interval.UHF-ECG depolarization maps represent a useful tool for the selection and setting of optimal cardiac resynchronization therapy.

Optimized CRT Stimulation Based on Ultra-High-Frequency QRS Analysis

“…As can be seen in [7], there could be some subjects for whom non-profiting from OPT settings and SMART settings is more beneficial (12%). However, the automatic SMARTdelay algorithm recommended non-biventricular stimulation for 44% of the cases (LV stimulation only), Figure 7.…”

Body Surface Potential Mapping: Contemporary Applications and Future Perspectives

“…Ultra high frequency (UHF) has seen applications to ECG analysis that could also readily be transferred to BSP map analysis. UHF has been applied to assess a range of cardiac conditions such as dyssynchrony and myocardial ischemia [161][162][163]. Extensions of UHF analysis to BSPM could leverage the increased spatial sampling of BSP maps in combination with the increased temporal sampling incorporated into UHF.…”