Electrocardiogram Belt guidance for left ventricular lead placement and biventricular pacing optimization.
Cardiac resynchronization therapy
Electrocardiographic imaging
Heart failure
SDAT
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
received:
21
09
2022
revised:
07
11
2022
accepted:
22
11
2022
medline:
3
4
2023
pubmed:
29
11
2022
entrez:
28
11
2022
Statut:
ppublish
Résumé
Patients with ischemic cardiomyopathy, non-left bundle branch block, or QRS duration <150 ms have a lower response rate to cardiac resynchronization therapy (CRT) than did other indicated patients. The ECG Belt system (EBS) is a novel surface mapping system designed to measure electrical dyssynchrony via the standard deviation of the activation times of the left ventricle. The objectives of this study were to evaluate the efficacy of the EBS in patients less likely to respond to CRT and to determine whether EBS use in lead placement guidance and device programming was superior to standard CRT care. This was a prospective randomized trial of patients with heart failure and EBS-guided CRT implantation and programming vs standard CRT care. The primary end point was relative change in left ventricular end-systolic volume from baseline to 6 months postimplantation. A total of 408 patients from centers in Europe and North America were randomized. Although both patients with EBS and control patients had a mean improvement in left ventricular end-systolic volume, there was no significant difference in relative change from baseline (P = .26). While patients with a higher baseline standard deviation of the activation times derived greater left ventricular reverse remodeling, improvement in electrical dyssynchrony did not correlate with the extent of reverse remodeling. The findings of the present study do not support EBS-guided therapy for CRT management of heart failure with reduced ejection fraction.
Sections du résumé
BACKGROUND
Patients with ischemic cardiomyopathy, non-left bundle branch block, or QRS duration <150 ms have a lower response rate to cardiac resynchronization therapy (CRT) than did other indicated patients. The ECG Belt system (EBS) is a novel surface mapping system designed to measure electrical dyssynchrony via the standard deviation of the activation times of the left ventricle.
OBJECTIVES
The objectives of this study were to evaluate the efficacy of the EBS in patients less likely to respond to CRT and to determine whether EBS use in lead placement guidance and device programming was superior to standard CRT care.
METHODS
This was a prospective randomized trial of patients with heart failure and EBS-guided CRT implantation and programming vs standard CRT care. The primary end point was relative change in left ventricular end-systolic volume from baseline to 6 months postimplantation.
RESULTS
A total of 408 patients from centers in Europe and North America were randomized. Although both patients with EBS and control patients had a mean improvement in left ventricular end-systolic volume, there was no significant difference in relative change from baseline (P = .26). While patients with a higher baseline standard deviation of the activation times derived greater left ventricular reverse remodeling, improvement in electrical dyssynchrony did not correlate with the extent of reverse remodeling.
CONCLUSION
The findings of the present study do not support EBS-guided therapy for CRT management of heart failure with reduced ejection fraction.
Identifiants
pubmed: 36442824
pii: S1547-5271(22)02679-0
doi: 10.1016/j.hrthm.2022.11.015
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT03504020']
Types de publication
Randomized Controlled Trial
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
537-544Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 Heart Rhythm Society. Published by Elsevier Inc. All rights reserved.