title: Non-invasive imaging of cardiac electrophysiology in a cardiac resynchronization therapy defibrillator patient with a quadripolar left ventricular lead.
abstract: OBJECTIVE
  The present study was aimed to assess epi- and endocardial ventricular electroanatomical activation during cardiac resynchronization therapy (CRT) by means of non-invasive imaging of cardiac electrophysiology (NICE) in a patient with a novel quadripolar LV lead.
  
  
  RESULTS
  Non-invasive imaging of cardiac electrophysiology is a novel imaging tool which works by fusing data from high-resolution electrocardiogram (ECG) mapping with a model of the patient's individual cardiothoracic anatomy created from magnetic resonance imaging. This was performed in a cardiac resynchronization therapy defribrillator (CRT-D) patient with a quadripolar left ventricular (LV) lead. Beat-to-beat endocardial and epicardial ventricular activation sequences were computed using NICE during intrinsic conduction as well as during different pacing modes with different LV and biventricular (biV) pacing vectors. The spatial resolution of NICE enabled discrimination of the different pacing vectors during LV and biV pacing. Biventricular pacing resulted in a marked shortening of the total activation duration (TAD) of both ventricles when compared with intrinsic conduction and RV and LV pacing.
  
  
  CONCLUSIONS
  Non-invasive imaging of cardiac electrophysiology facilitates non-invasive imaging of ventricular activation, which may be useful in CRT patients to locate the area of latest ventricular activation as the target area for LV lead placement. Moreover, especially in non-responders to CRT NICE may be further useful to determine the best electrical repositioning option.
authors.affiliation: Institute of Electrical, Electronic and Bioengineering, University for Health Sciences, Medical Informatics and Technology (UMIT), 6060 Hall i. Tirol, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Seger
authors.forename: Friedrich
authors.initials: F
authors.lastname: Hanser
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Dichtl
authors.forename: Markus
authors.initials: M
authors.lastname: Stuehlinger
authors.forename: Florian
authors.initials: F
authors.lastname: Hintringer
authors.forename: Thomas
authors.initials: T
authors.lastname: Trieb
authors.forename: Bernhard
authors.initials: B
authors.lastname: Pfeifer
authors.forename: Thomas
authors.initials: T
authors.lastname: Berger
mesh_terms: D002037:Bundle-Branch Block / Q000503:physiopathology / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D017147:Defibrillators, Implantable; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008955:Models, Cardiovascular; D012815:Signal Processing, Computer-Assisted
keywords: Cardiac resynchronization therapy; Electroanatomical mapping; NICE; Non-invasive imaging; Ventricular activation