Abstract
The optimal approach for CRT implantation is not established. To evaluate the feasibility of CRT implantation under electrocardiographic mapping guidance. Thirty consecutive patients with left ventricular ejection fraction (LVEF) ≤35% and conduction delay (9 LBBB and 21 non-LBBB) were recruited. A 252-electrode vest (CardioInsight, Medtronic) was worn by the patient during the procedure to measure the total activation time (TAT) when different pacing combinations of biventricular pacing (BVP), His-bundle pacing (HBP) and/or left bundle branch pacing (LBBP) were tested. The combination that resulted in the shortest TAT would be chosen. Clinical response was defined by ≥1 NYHA class improvement and echocardiographic response by LV end-systolic volume reduction ≥15% and/or LVEF improvement ≥10% at 6-months follow-up. Final pacing configurations involved LBBP in 40%, HBP in 33%, BVP in 13% and RV or LV pacing alone in 13% of patients. Mean QRS duration shortened from 164±18ms to 128±18ms and LVEF improved from 26±6% to 39±14% (both p <0.01). Clinical and echocardiographic response rates were 80% and 73%, respectively. Super echocardiographic responder rate (final LVEF >45%) was 33%. Mean TAT (57ms vs. 87ms) was significantly lower and TAT reduction (42% vs. 12%) was significantly greater with final pacing-configuration compared to BVP, respectively (both p<0.01). Personalized approach for CRT implantation using real-time non-invasive electrocardiographic mapping was feasible and associated with better resynchronization results compared to BVP.
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