CineECG Repolarization Gradients Predict Acute Hemodynamic Response in CRT Patients

Figures

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  Figure 1. Scheme of the biventricular pacing sequences used. The red circles represent active electrodes for different pacing protocols. Conventional biventricular pacing was performed using a right ventricular lead and a distal dipole of either an anterolateral (BVP LV1) or posterior/posterolateral (BVP LV2) leads. Multipoint pacing used the RV lead and two dipoles either from the anterolateral (MPP LV1) or posterior/posterolateral (MPP LV2) leads. Multisite pacing (MSP) was performed using the RV lead and the distal dipoles from both LV leads. Maximum multisite pacing (MSP‐max) used the RV lead and all the four dipoles of both LV leads.

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  Figure 2. Schematic presentation of processing of ECG data by the CineECG.

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  Figure 3. Mean path directions calculated for CineECG QRS‐complex in different pacing modes. The path directions Xh, Yh, and Zh correspond to the anteroposterior, interventricular, and apicobasal directions, respectively. *p < 0.05 versus RA pacing; RA, right atrial pacing; RV, right ventricular pacing; BVP LV1, conventional biventricular pacing with a distal anterolateral LV dipole; BVP LV2, conventional biventricular pacing with a distal posterior/posterolateral LV dipole; MPP LV1, multipoint pacing with two dipoles of the anterolateral LV lead; MPP LV2, multipoint pacing with two dipoles of the posterior/posterolateral LV lead; MSP, multisite pacing with the distal dipoles of both LV leads; MSP‐max, maximum multisite pacing with all the four dipoles of both LV leads.

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  Figure 4. Mean path directions calculated for CineECG ST‐T‐interval in different pacing modes. The path directions Xh, Yh, and Zh correspond to the anteroposterior, interventricular, and apicobasal directions, respectively. Note the opposite polarity of these directions for ST‐T and QRS path directions. *p < 0.05 versus RA pacing; RA, right atrial pacing; RV, right ventricular pacing; BVP LV1, conventional biventricular pacing with a distal anterolateral LV dipole; BVP LV2, conventional biventricular pacing with a distal posterior/posterolateral LV dipole; MPP LV1, multipoint pacing with two dipoles of the anterolateral LV lead; MPP LV2, multipoint pacing with two dipoles of the posterior/posterolateral LV lead; MSP, multisite pacing with the distal dipoles of both LV leads; MSP‐max, maximum multisite pacing with all the four dipoles of both LV leads.

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  Figure 5. The scatter‐plots of the distribution of dP/dt variables versus the mean interventricular ST‐T path direction (direction Yh). Panel A displays the distribution of dP/dt max obtained in all studied pacing modalities including RA, sequential RV, and all biventricular pacing modes. See that different modes tend to cluster together with RA pacing at the lower‐left and MSP and MSP‐max at the upper‐right. Panel B displays the distribution of the Δ dP/dt max in mm Hg obtained only in the biventricular pacing modes in respect to RA pacing. See that the same pacing protocol could produce a wide range of increments in dP/dt max corresponding to the wide range of ST‐T interventricular path directions. Panel C shows Δ dP/dt max in percent with the optimal cut‐off point of the interventricular ST‐T path (vertical line) associated with the achievement of the acute hemodynamic response of 10% (horizontal line) in respect to the RA pacing. See that the data obtained in different patients tend to cluster together. RA, right atrial pacing; RV, right ventricular pacing; BVP LV1, conventional biventricular pacing with a distal anterolateral LV dipole; BVP LV2, conventional biventricular pacing with…