Left ventricular pacing vector optimisation in an ideally deployed quadripolar lead in cardiac resynchronisation therapy: effect of optimising QRS area

• Published in: European journal of arrhythmia & electrophysiology 2019-01, Vol.5, p.33
• Main Authors: Oka, O, Umar, F, van Dam, P M, Walton, J, Stegemann, B, Zegard, A, Lencioni, M, de Bono, J, Marshall, H, Leyva, F
• Format: Article
• Language: English
• ISSN: 2058-3869; 2058-3877

Background: QRS area (QRSarea), derived from vectorcardiography (VCG) is a marker of delayed left ventricular (LV) activation. Objective: To determine whether changes in QRS area (ΔQRSarea) in LV lead vectors of a quadripolar lead (QUAD) relates to the acute haemodynamic response (AHR) to CRT. Methods: In this acute study, we performed 12-lead ECGs and measured LV pressure (LV dP/dtmax) in 25 CRT recipients (age: 69 ± [9.1] years, mean ± [SD], QRS: 150.8 ± 22.0 ms, LBBB in 19 [79.2%]) in whom a QUAD was deployed in a posterolateral position. VCGs were synthesized from digital ECGs using the Kors matrix. An AHR was defined as a ≥10% ΔLV dP/dtmax. Results: Intraindividually, the change in LV dP/dtmax across different LV pacing configurations of a QUAD (in relation to AAI pacing) ranged from a minimum of 0.95% to a maximum of 20.5% (7.3 ± 5.8%, mean ± SD). Intraindividually, the ΔQRSarea ranged from 2.8 to 75.7 μVs (27.5 ± 21.2 μVs, mean range ± SD). In regression analyses, ΔQRSarea (area under the curve [AUC] 0.87, 95% confidence intervals [CI]: 0.78–0.97, p