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ECG Imaging for Real-Time Assessment of Ventricular Synchrony in Physiological Pacing
Session:
Sessão de Posters 34 - Medicina Cardiovascular: Para além dos cardiologistas
Speaker:
Sofia Monteiro
Congress:
CPC 2024
Topic:
P. Other
Theme:
37. Miscellanea
Subtheme:
09.6 Device Therapy - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Sofia Monteiro; Sérgio Laranjo; Andreu Climent; Pedro Cunha; Helder Santos; Cátia Guerra; Margarida Paulo; Mário Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Background: </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Left bundle branch pacing (LBBP) and His Bundle pacing (HBP) deliver physiological ventricular pacing, which aims to preserve or restore the electrical and mechanical synchrony of the ventricles. Electrocardiographic imaging (ECGi) allows the evaluation of the cardiac substrate non-invasively and can be used to guide lead placement during implantation.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Methods: </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Four patients referred for physiological pacing were included. Three were male, with ages of 64±27 years and LVEF of 52±17%. Two had an indication for cardiac resynchronization and two for pacemaker implantation due to symptomatic bradycardia. Sequential ECGi acquisitions were obtained in real-time during the lead implantation procedure without the need for CT or MRI imaging. The cardiac geometry and localization were estimated based on an artificial intelligence algorithm. Epicardial electrograms were computed to obtain ventricular local activation time maps. Intra- and interventricular synchrony were assessed by evaluating activation patterns and by calculating the total ventricular activation time (TAT).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Results: </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">ECGi was able to localize ventricular pacing sites during lead implantation. In patients with bundle branch block, the basal maps showed heterogeneous interventricular conduction, with marked delayed activation at the block site. Electrical synchrony was restored after LBBP lead implantation (Panel A). In the patients that had normal basal conduction (without cardiac resynchronization indication), physiological ventricular pacing preserved the intra- and interventricular activation (Panel B).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Conclusions: </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">ECGi enables real-time, non-invasive monitoring of ventricular activation, and may be used to assess ventricular synchrony in different physiological pacing applications.</span></span></span></p> <p> </p>
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