Noninvasive Electrical Mapping Compared with the Paced QRS Complex for Optimizing CRT Programmed Settings and Predicting Multidimensional Response

The aim was to test the hypothesis that left ventricular (LV) and right ventricular (RV) activation from body surface electrical mapping (CardioInsight 252-electrode vest, Medtronic) identifies optimal cardiac resynchronization therapy (CRT) pacing strategies and outcomes in 30 patients. The LV80, RV80, and BIV80 were defined as the times to 80% LV, RV, or biventricular electrical activation. Smaller differences in the LV80 and RV80 (|LV80-RV80|) with synchronized LV pacing predicted better LV function post-CRT ( p = 0.0004) than the LV-paced QRS duration ( p = 0.32). Likewise, a lower RV80 was associated with a better pre-CRT RV ejection fraction by CMR ( r = − 0.40, p = 0.04) and predicted post-CRT improvements in myocardial oxygen uptake ( p = 0.01) better than the biventricular-paced QRS ( p = 0.38), while a lower LV80 with BIV pacing predicted lower post-CRT B-type natriuretic peptide (BNP) ( p = 0.02). RV pacing improved LV function with smaller |LV80-RV80| ( p = 0.009). In conclusion, 3-D electrical mapping predicted favorable post-CRT outcomes and informed effective pacing strategies. Graphical Abstract