B-PO01-100 PERSONALIZED APPROACH FOR CARDIAC RESYNCHRONIZATION THERAPY (CRT) IMPLANTATION GUIDED BY REAL-TIME NON-INVASIVE 3D ELECTROCARDIOGRAPHIC MAPPING

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.