Quantitative Analysis of Lead Position vs. Correction of Electrical Dyssynchrony in an Experimental Model of LBBB/CRT
Cardiac resynchronization therapy (CRT) is a recommended treatment in patients with electrical dyssynchrony such as left bundle branch block (LBBB). The determination of the optimal leads position, and the quantification of the changes in electrical activation are two current major challenges. In this paper, we investigate these aspects through electroanatomical data from a controlled experimental protocol, which studied pigs with no structural disease under LBBB and CRT conditions. We propose to use a quasi-conformal mapping technique to standardize electroanatomical maps of endo- and epi-cardial walls of both ventricles to a common reference geometry, in which simple quantitative indices can be computed. Then, we investigate the relation between leads and simple surrogates of the recovery of the electrical activation based either on total activation times or on the spatial distribution of the patterns. Our methodology allows a better understanding of the complex electrical activation patterns in LBBB and CRT, and confirms hypotheses about the optimal leads position from previous studies.
KeywordsElectro-anatomical mapping LBBB CRT
This study was partially founded by the Spanish Ministry of Science and Innovation (TIN2011-28067) and the Spanish Industrial and Technological Development Center (cvREMOD-CEN-20091044). The authors gratefully acknowledge the support of N Solanes, M Rigol, E Silva, A Doltra, L Gabrielli, L Mont, J Brugada (Hospital Clnic, Barcelona, Spain) and A Barcelo (Sorin Group, Barcelona, Spain) on the experimental protocol.
- 7.Soto-Iglesias, D., Butakoff, C., Andreu, D., Fernández-Armenta, J., Berruezo, A., Camara, O.: Evaluation of different mapping techniques for the integration of electro-anatomical voltage and imaging data of the left ventricle. In: Ourselin, S., Rueckert, D., Smith, N. (eds.) FIMH 2013. LNCS, vol. 7945, pp. 391–399. Springer, Heidelberg (2013) CrossRefGoogle Scholar
- 9.Lam, K.C., et al.: Genus-one surface registration via teichmüller extremal mapping. MICCAI 3, 25–32 (2014)Google Scholar
- 11.Soto-Iglesias, D., et al.: Analyzing electrical patterns in an experimental swine model of dyssynchrony and CRT. In: IEEE Computing in Cardiology (CINC 2013), vol. 40, pp. 623–626 (2013)Google Scholar
- 13.Jing, L., et al.: Patients with repaired tetralogy of fallot suffer from intra- and inter-ventricular cardiac dyssynchrony: a cardiac magnetic resonance study. J. Cardiovasc. Imaging 12, 1333–1343 (2014)Google Scholar
- 14.MacQueen, J.: Some methods for classification and analysis of multivariate observations. In: Proceedings of the Fifth BSMSP, Statistics, vol. 1, pp. 281–297 (1967)Google Scholar