Three-dimensional electroanatomical mapping guidelines for the selection of pacing site to achieve cardiac resynchronization therapy

Bao-Tong Hua; Li-Jin Pu; Xin Tian; Wen-Juan Song; Hao Li; Chao Wang; Xiao-Xia Shao; Rui Li; Shu-Min Li; Zhi-Xuan Li; Jun-Hua Zou; Ling Zhao; Jing Wang

doi:10.3389/fcvm.2022.843969

Three-dimensional electroanatomical mapping guidelines for the selection of pacing site to achieve cardiac resynchronization therapy

Front Cardiovasc Med. 2022 Sep 30:9:843969. doi: 10.3389/fcvm.2022.843969. eCollection 2022.

Authors

Bao-Tong Hua¹, Li-Jin Pu², Xin Tian², Wen-Juan Song², Hao Li¹, Chao Wang², Xiao-Xia Shao², Rui Li², Shu-Min Li², Zhi-Xuan Li², Jun-Hua Zou², Ling Zhao², Jing Wang¹

Affiliations

¹ Department of Geriatric Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.
² Department of Cardiology, The First Affiliated Hospital of Kunming Medical University, Kunming, China.

Abstract

Objectives: We aimed to evaluate the feasibility of left ventricular electroanatomical mapping to choose between left bundle branch area pacing (LBBAP) or coronary venous pacing (CVP).

Background: There are several ways to achieve left ventricular activation in cardiac resynchronization therapy (CRT): LBBAP and CVP are two possible methods of delivering CRT. However, the criteria for choosing the best approach remains unknown.

Methods: A total of 71 patients with heart failure, reduced ejection fraction, and left bundle branch block (LBBB) were recruited, of which 38 patients underwent the three-dimensional electroanatomical mapping of the left ventricle to accurately assess whether the left bundle branch was blocked and the block level, while the remaining 33 patients were not mapped. Patients with true LBBB achieved CRT by LBBAP, while patients with pseudo-LBBB achieved CRT by CVP. After a mean follow-up of 6 months and 1 year, the QRS duration and transthoracic echocardiography, including mechanical synchrony indices, were evaluated.

Results: Twenty-five patients with true LBBB received LBBAP, while 13 without true LBBB received CVP. Seventeen patients received LBBAP, and 16 patients received CVP without mapping. Paced QRS duration after the implantation of LBBAP and CVP was significantly narrower in the mapping subgroup compared to the non-mapping subgroup. A significant increase in post-implantation left ventricular ejection fraction was observed in patients with LBBAP or CVP, and the mapping subgroup were better than the non-mapping subgroup. After a 12-month follow-up, atrioventricular, intraventricular, and biventricular synchronization were significantly improved in the mapping subgroup compared to non-mapping groups in both LBBAP and CVP.

Conclusion: In our study, three-dimensional electroanatomical mapping was used to choose LBBAP or CVP for heart failure patients, which proved feasible, with better cardiac resynchronization in the long-term follow-up. Therefore, three-dimensional electroanatomical mapping before CRT appears to be a reliable method for heart failure patients with LBBB who are indicated for CRT.

Keywords: cardiac resynchronization therapy (CRT); coronary venous pacing; heart failure; left bundle branch area pacing; three-dimensional electroanatomical mapping.