169-08: Electrical drivers of hemodynamic response to cardiac resynchronization therapy

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Introduction: The drivers of cardiac resynchronization therapy (CRT) response remain unclear. We combined clinical electrocardiographic imaging (ECGi) data with cardiovascular model simulations (CircAdapt) to investigate how inter- and intra-ventricular dispersion of activation influences acute hemodynamic CRT response. Results: Computed changes of LVdP/dtmax based on both VEU and DISP data showed good agreement with measurements (FIG.A). High baseline VEU appeared to be both essential and sufficient for acute CRT response (FIG.A&B). When the VEU substrate was absent, response to CRT varied from worsening to slight improvement of hemodynamic function, depending on DISP. Consequently, including DISP as an input parameter in CircAdapt improved response prediction for the NICD and NARROW patient groups (FIG.A). Conclusion: Combining electrical activation from ECGi with computer simulations predicts hemodynamic improvement following CRT. VEU, representing interventricular dispersion of activation, is the dominant driver of CRT response. In patients with low baseline values for VEU, intraventricular dispersion of activation, characterized by DISP, is a strong determinant of baseline hemodynamic function and thereby additive as a predictor of response to CRT.