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Electrical activation versus mechanical contraction in cardiac resynchronization therapy recipients:comparison between electroanatomical mapping and feature-tracking cardiovascular magnetic resonance

Session Rapid Fire 5: improving the response to cardiac resynchronization therapy: emerging technologies

Speaker Osita Okafor

Congress : EHRA 2019

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Rapid Fire Abstracts
  • FP Number : 921

Authors : O Okafor (Birmingham,GB), F Umar (Birmingham,GB), A Zegard (Birmingham,GB), H Marshall (Birmingham,GB), S Flannigan (Birmingham,GB), M Lencioni (Birmingham,GB), J De Bono (Birmingham,GB), M Griffith (Birmingham,GB), F Leyva (Birmingham,GB)


O Okafor1 , F Umar2 , A Zegard1 , H Marshall3 , S Flannigan3 , M Lencioni3 , J De Bono3 , M Griffith3 , F Leyva1 , 1Aston University, Aston Medical Research Institute - Birmingham - United Kingdom , 2University of Birmingham, Centre for Cardiovascular Sciences - Birmingham - United Kingdom , 3Queen Elizabeth Hospital Birmingham, Department of Cardiology - Birmingham - United Kingdom ,


Background: There is debate as to whether left ventricular (LV) lead pacing during cardiac resynchronization therapy (CRT) should be targeted to myocardial segments that are latest electrically activated or latest contracting.

Purpose: To determine whether the acute haemodynamic response (AHR) to CRT is governed by LV lead deployment over the latest electrically activated segment (LEAS; electroanatomical mapping [Ensite]) or latest mechanically activated segment (LMAS; longest time to peak (TTP) circumferential strain on feature-tracking cardiovascular magnetic resonance (FT-CMR).

Methods: In this acute study, 14 CRT recipients with a pre-implantation CMR scan underwent CRT. The AHR was assessed using the change in the rate of rise of LV pressure (?dP/dt), in relation to AAI pacing. The LEAS was defined as a Q-LV>95ms.  The LMAS was identified using as the latest contracting segment using TTP circumferential strain on FT-CMR, undertaken during intrinsic rhythm.

Results: There was a correlation between LEAS and ?dP/dt (r=0.66, p=0.01), but not between LMAS and ?dP/dt (r=0.36, p=0.21).  In 12/14 (85.7%) patients, the LMAS was either within or adjacent to myocardial scar. There was no agreement between LEAS and LMAS in 11/14 (78.6%) patients. 

Conclusion: Targeting LV pacing to LEAS achieves a superior AHR than targeting to LMAS. LMAS are likely to harbour myocardial scars. These findings support the use of an electrical rather than a mechanical (imaging) approach to LV lead deployment in CRT.

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