Optimal depolarization sequence for cardiac resynchronization therapy patients.
5 affiliations
- 1Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University in Prague, Sitna Sq. 3105, Kladno 272 01, Czech Republic.
- 2Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague 140 21, Czech Republic.
- 3Center for Digital Medicine and Robotics, Jagiellonian University Medical College, Kopernika 7E, Krakow 31-034, Poland.
- 4Department of Cardiology, Cardiocenter, Third Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, Ruska 87, Prague 100 00, Czech Republic.
- 5International Clinical Research Center, St. Anne's University Hospital, Pekarska 53, Brno 602 00, Czech Republic.
Abstract
Aims
Electrical ventricular dyssynchrony is a hallmark of intraventricular conduction disease in heart failure with reduced ejection fraction. Although cardiac resynchronization therapy (CRT) is effective, a proportion of patients with electrical dyssynchrony evidenced by an electrocardiogram (ECG) remain non-responders. Besides the QRS duration, visualization and quantification of the depolarization sequence could contribute to improving CRT response. The study aimed to evaluate the CineECG-derived mean temporo-spatial isochrone trajectory of depolarization in CRT patients.Methods and results
Among the adult cohort of 121 patients who underwent CRT implantation, there were 93 (33% female) responders and 28 (7% female) non-responders. ECGs recorded before and immediately after CRT implantation were collected and analysed using the CineECG modality with a generic heart/torso model. The CineECG-derived path directions were computed for the QRS on anteroposterior, interventricular, and apicobasal axes within the cardiac anatomy. Spatial depolarization characteristics were tested for the association with left ventricle reverse-remodelling at 6-month follow-up. The pre-implantation depolarization sequence was predominantly from the right to the left ventricle, and after the CRT implant, it has been transformed into an apicobasal direction. In multivariate logistic regression, the pre-implant QRS duration, apicobasal depolarization gradient, and CRT-induced QRS shortening independently predicted CRT response. The Akaike information criterion indicated that combining all three yielded the strongest predictive model.Conclusion
CineECG-derived depolarization gradients, which reflect ventricular activation sequence, changed significantly after CRT, and the pre-implantation apicobasal gradient independently predicted echocardiographic outcome, with a less pronounced gradient associated with better haemodynamic response.
Related
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BibTeX
@article{sedova2026optimal,
title = {{Optimal depolarization sequence for cardiac resynchronization therapy patients.}},
author = {Ksenia Sedova and Jan Azarov and Peter M Van Dam and Karol Curila and Pavel Leinveber and Josef Kautzner},
journal = {European heart journal open},
year = {2026},
month = sep,
doi = {10.1093/ehjopen/oeag165},
url = {https://europepmc.org/article/MED/42923679},
note = {CC BY},
}
RIS
TY - JOUR
TI - Optimal depolarization sequence for cardiac resynchronization therapy patients.
AU - Ksenia Sedova
AU - Jan Azarov
AU - Peter M Van Dam
AU - Karol Curila
AU - Pavel Leinveber
AU - Josef Kautzner
PY - 2026
DA - 2026/09/01
JO - European heart journal open
DO - 10.1093/ehjopen/oeag165
UR - https://europepmc.org/article/MED/42923679
AB - Aims Electrical ventricular dyssynchrony is a hallmark of intraventricular conduction disease in heart failure with reduced ejection fraction. Although cardiac resynchronization therapy (CRT) is effective, a proportion of patients with electrical dyssynchrony evidenced by an electrocardiogram (ECG) remain non-responders. Besides the QRS duration, visualization and quantification of the depolarization sequence could contribute to improving CRT response. The study aimed to evaluate the CineECG-derived mean temporo-spatial isochrone trajectory of depolarization in CRT patients.Methods and results Among the adult cohort of 121 patients who underwent CRT implantation, there were 93 (33% female) responders and 28 (7% female) non-responders. ECGs recorded before and immediately after CRT implantation were collected and analysed using the CineECG modality with a generic heart/torso model. The CineECG-derived path directions were computed for the QRS on anteroposterior, interventricular, and apicobasal axes within the cardiac anatomy. Spatial depolarization characteristics were tested for the association with left ventricle reverse-remodelling at 6-month follow-up. The pre-implantation depolarization sequence was predominantly from the right to the left ventricle, and after the CRT implant, it has been transformed into an apicobasal direction. In multivariate logistic regression, the pre-implant QRS duration, apicobasal depolarization gradient, and CRT-induced QRS shortening independently predicted CRT response. The Akaike information criterion indicated that combining all three yielded the strongest predictive model.Conclusion CineECG-derived depolarization gradients, which reflect ventricular activation sequence, changed significantly after CRT, and the pre-implantation apicobasal gradient independently predicted echocardiographic outcome, with a less pronounced gradient associated with better haemodynamic response.
SN - 2752-4191
ER -