Impact of anatomical reverse remodelling in the design of optimal quadripolar pacing leads: A computational study. (January 2022)

• Record Type: Journal Article
• Authors: Rodero, Cristobal; Strocchi, Marina; Lee, Angela W.C.; Rinaldi, Christopher A.; Vigmond, Edward J.; Plank, Gernot; Lamata, Pablo; Niederer, Steven A.
• Is Part Of: Computers in biology and medicine. Volume 140(2022)
• Publication Date: 2022-01
• Subjects: Multipoint pacing -- Multipolar pacing -- Lead optimization -- CRT -- Virtual cohort -- Digital twin; Medicine -- Data processing -- Periodicals; Biology -- Data processing -- Periodicals; 610.285
• DOI: 10.1016/j.compbiomed.2021.105073
• Languages: English
• ISSNs: 0010-4825

Abstract

Abstract: Lead position is an important factor in determining response to Cardiac Resynchronization Therapy (CRT) in dyssynchronous heart failure (HF) patients. Multipoint pacing (MPP) enables pacing from multiple electrodes within the same lead, improving the potential outcome for patients. Virtual quadripolar lead designs were evaluated by simulating pacing from all combinations of 1 and 2 electrodes along the lead in each virtual patient from cohorts of HF (n = 24) and simulated reverse remodelled (RR, n = 20) patients. Electrical synchrony was assessed by the time 90% of the ventricular myocardium is activated (AT090). Optimal 1 and 2 electrode pacing configurations for AT090 were combined to identify the 4-electrode lead design that maximised benefits across all patients. LV pacing in the HF cohort in all possible single and double electrode locations reduced AT090 by 14.48 ± 5.01 ms (11.92 ± 3.51%). The major determinant of reduction in activation time was patient anatomy. Pacing with a single optimal lead design reduced AT090 more in the HF cohort than the RR cohort (12.68 ± 3.29% vs 10.81 ± 2.34%). Pacing with a single combined HF and RR population-optimised lead design achieves electrical resynchronization with near equivalence to personalised lead designs both in HF and RR anatomies. These findings suggest that although lead configurations have to be tailored to each patient, a single optimal lead design is sufficient to obtain near-optimal results across most patients. This study shows the potential of virtual clinical trials as tools to compare existing and explore new lead designs. Highlights: A common optimal multi-pole lead design delivers a similar reduction in activation times with CRT compared to personalised lead designs. As the heart remodels the benefit of CRT on the reduction in activation time decreases. This study shows the potential of virtual clinical trials as tools to explore new pacing lead designs.