Basic/Translational Science -> Computer Modeling/Simulation D-PO03 - Poster Session III (ID 48) Poster

D-PO03-020 - Optimal Number Of Multipolar Lead Designs For Cardiac Resynchronization Therapy Is Preserved After Reverse Remodeling (ID 274)

Abstract

Background: Multipolar pacing can improve acute response to Cardiac Resynchronization Therapy (CRT). However, the optimal locations for the electrode poles along the lead varies across patients and could also change during reverse remodeling of the heart.
Objective: We aim to determine the multipolar lead designs (number of electrodes and location along the lead) that are required to optimize activation patterns in dyssynchronous heart failure (HF) and reverse remodeled hearts (RR).
Methods: We created a virtual cardiac cohort of 24 HF and 20 RR patients with CT-based anatomy. RR hearts were approximated by asymptomatic patients. We simulated biventricular pacing using a lead design with 8 possible electrode positions spaced at 7.5 mm. We activated up to 4 at a time. Each of these leads was placed at 5 potential vein locations in the LV free wall. In total 35684 electrophysiology simulations were performed. CRT response was quantified by QRS duration (QRSd).
Results: HF, RR and combined RR and HF patients require 5, 5 and 9 different lead designs to achieve optimal pacing in all patients. Using the optimal lead in each patient the QRSd is decreased by 7.9±1.6% and 12.0±3.0% in RR and HF hearts, respectively. Using 9 lead designs lead to 10.1±3.2% decrease in QRSd across all hearts. Optimal lead designs preferentially include a combination of basal and mid to apical electrodes.
Conclusion: To achieve optimal multipolar pacing requires lead design to be tailored to the individual patient. Optimal lead designs are the same in HF and RR patients. Between 5 and 9 lead designs are required to cover the CRT patient population.
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