Biomedical Engineering Reference
In-Depth Information
The Dependence of Clinical Metrics of Cardiac
Function on Lead Position in Cardiac
Resynchronization Therapy: A Biophysical
Modeling Study
Steven Niederer, Gernot Plank, Reza Rezavi, Aldo Rinaldi, and Nic Smith
Abstract Lead placement in cardiac resynchronization therapy (CRT) has been
identified as an important variable that can potentially be manipulated at the time of
implantation. Recent studies have demonstrated the variability of the acute hemo-
dynamic response of patients to different lead positions and have proposed different
strategies to identify the optimal lead location. In clinical studies of lead position
the maximum rate of pressure development is used as a single scalar measure of the
efficacy of an individual pacing location, despite limited clinical evidence that this
correlates with long term outcomes. In this study, we use a patient-specific compu-
tational model to evaluate metrics of cardiac function for different lead positions.
The model predicts a large, common, optimal location for all evaluated metrics.
This supports use of the maximum rate of pressure development as a representation
of general cardiac function for optimizing CRT.
1
Introduction
Heart failure (HF) cardiac resynchronization therapy (CRT) is an established
treatment for patients with HF and dyssynchronous contraction, which is usually
manifested on the surface ECG as left bundle branch block (LBBB). CRT seeks to
improve the temporal homogeneity of contraction in the failing heart improving
heart function, morbidity and quality of life. However, 30-40% of patients fail to
respond to the treatment [
1
].
Recent clinical studies have aimed to improve this response rate by optimizing
the position of the pacing lead. Acute studies for evaluating lead position have used
S. Niederer (
*
) • R. Rezavi • A. Rinaldi • N. Smith
Imaging Sciences & Biomedical Engineering Division, King's College, London, UK
e-mail:
steven.niederer@kcl.ac.uk
G. Plank
Institut f
€
ur Biophysik Medizinische Universit
€
at Graz, Graz, Austria
