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September 21, 2022Frontiers in PhysiologyOpen Access

Non-invasive estimation of QLV from the standard 12-lead ECG in patients with left bundle branch block

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Why the study?

Optimal LV lead placement in CRT is limited by the inability to measure QLV non-invasively before implantation.

Can a standard 12-lead ECG and generic heart model accurately estimate QLV non-invasively in patients with LBBB undergoing CRT?

Population

135 standard CRT recipients

Comparison

Non-invasively estimated QLV vs measured procedural QLV

Design

Validation study using procedural recordings and forward ECG modeling

Authors

JMJacob MelgaardAalborg UniversityPDPeter van DamJagiellonian UniversityASA SommerElectrophysiology

Discussion

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Implication

May support pre-procedural CRT planning in LBBB; leaves open outcome benefits pending prospective validation.

Structured PICO

Can a standard 12-lead ECG and generic heart model accurately estimate QLV non-invasively in patients with LBBB undergoing CRT?

P
Population
135 patients with heart failure and left bundle branch block (LBBB) in sinus rhythm undergoing cardiac resynchronization therapy (CRT) implantation
I
Intervention
Non-invasive estimation of QLV (time from Q wave onset to LV sensing) using a standard 12-lead ECG and a generic heart model (The Mapper algorithm)
C
Comparator
Invasively measured QLV from procedural recordings during CRT implantation
O
Outcome
Time difference between non-invasively estimated QLV and procedurally measured QLV (ΔQLV)surrogate

A novel non-invasive method using a standard 12-lead ECG and generic heart model can accurately estimate QLV, potentially aiding in pre-procedural planning for optimal LV lead placement in CRT.

Limitations

  • Generic model does not take local heart curvature and anisotropy into account
  • Bath loading effects were not included in the simulation
  • Does not take ischemia or scarring into account
  • The Mapper algorithm is limited to six initial activation sites and uniform conduction velocity

Cite This Study

Melgaard et al. (2022) studied this question.

synapsesocial.com/papers/6a0f8c57b6f5ee04015fcb71https://doi.org/10.3389/fphys.2022.939240

Topics

HFrEF treatmentHeart failure
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Multimodality Imaging-Guided Left Ventricular Lead Placement in Cardiac Resynchronization Therapy: A Randomized Controlled Trial2016 · 134 citations
  2. 2Empiric versus imaging guided left ventricular lead placement in cardiac resynchronization therapy (ImagingCRT): study protocol for a randomized controlled trial2013 · 30 citations
  3. 3Evaluating strict and conventional left bundle branch block criteria using electrocardiographic simulations2013 · 69 citations
  4. 4Modeling the His-Purkinje Effect in Non-invasive Estimation of Endocardial and Epicardial Ventricular Activation2022 · 11 citations
  5. 5Non-Invasive Imaging of Cardiac Activation and Recovery2009 · 174 citations