A rule-based method for predicting the electrical activation of the heart with cardiac resynchronization therapy from non-invasive clinical data.

A.W.C Lee,O Razeghi,C.A Rinaldi,J Behar,K Vernooy,U.C Nguyen,M Mafi-Rad,F.W Prinzen,B Sieniewicz,S Niederer,G Plank,J Gould,B.S Sidhu

doi:10.1016/j.media.2019.06.017

Abstract

BackgroundCardiac Resynchronization Therapy (CRT) is one of the few effective treatments for heart failure patients with ventricular dyssynchrony. The pacing location of the left ventricle is indicated as a determinant of CRT outcome.ObjectivePatient specific computational models allow the activation pattern following CRT implant to be predicted and this may be used to optimize CRT lead placement.MethodsIn this study, the effects of heterogeneous cardiac substrate (scar, fast endocardial conduction, slow septal conduction, functional block) on accurately predicting the electrical activation of the LV epicardium were tested to determine the minimal detail required to create a rule based model of cardiac electrophysiology. Non-invasive clinical data (CT or CMR images and 12 lead ECG) from eighteen patients from two centers were used to investigate the models.ResultsValidation with invasive electro-anatomical mapping data identified that computer models with fast endocardial conduction were able to predict the electrical activation with a mean distance errors of 9.2 ± 0.5 mm (CMR data) or (CT data) 7.5 ± 0.7 mm.ConclusionThis study identified a simple rule-based fast endocardial conduction model, built using non-invasive clinical data that can be used to rapidly and robustly predict the electrical activation of the heart. Pre-procedural prediction of the latest electrically activating region to identify the optimal LV pacing site could potentially be a useful clinical planning tool for CRT procedures.

Highlights

Cardiac resynchronization therapy (CRT) has emerged as an effective therapy for heart failure patients with ventricular conduction disturbances, such as left bundle branch block (LBBB), resulting in a dyssynchronous ventricular activation
The electrical activation for each of the models was simulated for each of the 14 cardiac magnetic resonance (CMR) cases with the conduction velocity along the fiber directions for the bulk myocardium characterized by the QRS duration
Tukey post-hoc test indicated that the fast endocardial conduction model was the only model that had a significantly reduced mean distance error (9.2 mm ± 0.5 mm) in comparison to the other models (15.6–16.9 mm ± 0.5 mm)

Summary

Introduction

Cardiac resynchronization therapy (CRT) has emerged as an effective therapy for heart failure patients with ventricular conduction disturbances, such as left bundle branch block (LBBB), resulting in a dyssynchronous ventricular activation. The optimal pacing site has been proposed to be located at the latest activating regions (Khan et al, 2012; Saba et al, 2013; Zanon et al, 2014) and outside of scar (Khan et al, 2009; Leyva et al, 2011; Singh et al, 2011). The pacing location of the left ventricle is indicated as a determinant of CRT outcome

Methods

Results

Discussion

Conclusion