Lead implantation in the late activation zone of the left ventricle determined by preoperative noninvasive mapping to improve the efficacy of cardiac resynchronization therapy

Aim. In a prospective study to determine whether implantation of a left ventricular lead (LVL) into the zone of late electrical activation of left ventricle (LV) determined by noninvasive electrophysiological mapping before implantation increases the number of responders to cardiac resynchronization therapy (CRT) compared to standard approach. To evaluate the dependence of the response to CRT on the position of the stimulating pole of the LVL in relation to the zone of late activation during the native rhythm.

Methods. The study included two groups of patients with indications for CRT of I and II a class according to the European Society of Cardiology recommendations on pacing and resynchronization therapy in 2021. In the main group (n=60) noninvasive electrophysiological mapping (NEM) was performed before implantation in order to determine the zone of late electrical activation of the LV. Patients in the control group (n=60) underwent standard implantation without NEM procedure. The response to CRT in both groups was compared. The influence of the distance from the stimulating pole of LVL to the late zone of LV activation at the initial rhythm (distance LVL-late zone) on the formation of response to CRT was analyzed.

Results. Analysis of conjugation of response to CRT depending on the group demonstrated statistically significant differences between the number of responders/ non-responders to CRT in the main and control groups (51/9 vs. 38/22, respectively, p<0.01). Analysis of the dependence of the response to CRT on the LVL-late zone distance in both groups revealed a statistically significant influence of this indicator: Pearson Chi-square Criterion = 50.27, p<0.01. According to the logistic regression equation, a significant increase in the probability of no response to CRT from 0 points to 1 point occurred in the range of LVL-late zone distance values of 46-57 mm. The probability of response was minimal in case the value exceeded 57 mm.

Conclusions. Targeted implantation of LVL into the late zone determined by NEM significantly increases the probability of response to CRT. When the distance from the stimulating pole of LVL to the late zone is ˃57 mm, the probability of a response to CRT is minimal.

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