Impact of CRT Device Settings on Interventricular Dyssynchrony: An Analysis Using Non-Invasive Activation Map Reconstruction

Abstract

Cardiac Resynchronization Therapy (CRT) is an effective treatment for heart failure patients with Left Bundle Branch Block (LBBB).However, selection of the optimal interventricular delay (VV) of CRT device remains challenging due to patient-specific variability.This study aimed to improve CRT efficacy by means of a non-invasive method to reconstruct cardiac activation maps and choose optimal VV delay.Retrospective data from five LBBB pattern patients who underwent CRT were analyzed.A previously developed algorithm generated patient-specific activation maps using 12-lead electrocardiogram (ECG) and computed tomography data.To model torso potential distributions, a forward ECG problem was solved and machine learning compared the simulated and real 12 lead signals.ECG recordings at different VV delays were tested using Spearman's correlation coefficient.The overall mean correlation was 0.73 ± 0.09, demonstrating quite high quality in the mapping technique.The variability in dyssynchrony indices across patients highlights the need for personalized selection of VV delay in the CRT device.These results suggest that the integration of imaging and computational modeling may improve CRT outcome by tailoring therapy to individual characteristics.

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