Introduction: The changes in ventricular repolarization after cardiac resynchronization therapy (CRT) are poorly understood. This knowledge gap is addressed using a multimodality approach including electrocardiographic and echocardiographic measurements in patients and using patient-specific computational modeling. Methods: In 33 patients electrocardiographic and echocardiographic measurements were performed before and at various intervals after CRT, both during CRT-ON and temporary CRT-OFF. T-wave area was calculated from vectorcardiograms, and reconstructed from the 12-lead electrocardiography (ECG). Computer simulations were performed using a patient-specific eikonal model of cardiac activation with spatially varying action potential duration (APD) and repolarization rate, fit to a patient's ECG. Results: During CRT-ON T-wave area diminished within a day and remained stable thereafter, whereas QT-interval did not change significantly. During CRT-OFF T-wave area doubled within 5 days of CRT, while QT-interval and peak-to-end T-wave interval hardly changed. Left ventricular (LV) ejection fraction only increased significantly increased after 1 month of CRT. Computer simulations indicated that the increase in T-wave area during CRT-OFF can be explained by changes in APD following chronic CRT that are opposite to the change in CRT-induced activation time. These APD changes were associated with a reduction in LV dispersion in repolarization during chronic CRT. Conclusion: T-wave area during CRT-OFF is a sensitive marker for adaptations in ventricular repolarization during chronic CRT that may include a reduction in LV dispersion of repolarization.

Synchronization of repolarization after cardiac resynchronization therapy: A combined clinical and modeling study / Verzaal, Nienke J; van Deursen, Caroline J M; Pezzuto, Simone; Wecke, Liliane; van Everdingen, Wouter M; Vernooy, Kevin; Delhaas, Tammo; Auricchio, Angelo; Prinzen, Frits W. - In: JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY. - ISSN 1045-3873. - 33:8(2022), pp. 1837-1846. [10.1111/jce.15581]

Synchronization of repolarization after cardiac resynchronization therapy: A combined clinical and modeling study

Pezzuto, Simone;
2022-01-01

Abstract

Introduction: The changes in ventricular repolarization after cardiac resynchronization therapy (CRT) are poorly understood. This knowledge gap is addressed using a multimodality approach including electrocardiographic and echocardiographic measurements in patients and using patient-specific computational modeling. Methods: In 33 patients electrocardiographic and echocardiographic measurements were performed before and at various intervals after CRT, both during CRT-ON and temporary CRT-OFF. T-wave area was calculated from vectorcardiograms, and reconstructed from the 12-lead electrocardiography (ECG). Computer simulations were performed using a patient-specific eikonal model of cardiac activation with spatially varying action potential duration (APD) and repolarization rate, fit to a patient's ECG. Results: During CRT-ON T-wave area diminished within a day and remained stable thereafter, whereas QT-interval did not change significantly. During CRT-OFF T-wave area doubled within 5 days of CRT, while QT-interval and peak-to-end T-wave interval hardly changed. Left ventricular (LV) ejection fraction only increased significantly increased after 1 month of CRT. Computer simulations indicated that the increase in T-wave area during CRT-OFF can be explained by changes in APD following chronic CRT that are opposite to the change in CRT-induced activation time. These APD changes were associated with a reduction in LV dispersion in repolarization during chronic CRT. Conclusion: T-wave area during CRT-OFF is a sensitive marker for adaptations in ventricular repolarization during chronic CRT that may include a reduction in LV dispersion of repolarization.
2022
8
Verzaal, Nienke J; van Deursen, Caroline J M; Pezzuto, Simone; Wecke, Liliane; van Everdingen, Wouter M; Vernooy, Kevin; Delhaas, Tammo; Auricchio, Angelo; Prinzen, Frits W
Synchronization of repolarization after cardiac resynchronization therapy: A combined clinical and modeling study / Verzaal, Nienke J; van Deursen, Caroline J M; Pezzuto, Simone; Wecke, Liliane; van Everdingen, Wouter M; Vernooy, Kevin; Delhaas, Tammo; Auricchio, Angelo; Prinzen, Frits W. - In: JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY. - ISSN 1045-3873. - 33:8(2022), pp. 1837-1846. [10.1111/jce.15581]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11572/360110
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