Optimization of left ventricular lead position based on a computer model of the heart for cardiac resynchronization therapy

Abstract

Cardiac resynchronization therapy (CRT) is one of the recommended therapy for patients with heart failure and left bundle branch block. However, up to 30% of appropriately selected patients remain non-responders to CRT. This study presents an automatic non-invasive method for optimizing the lead position in the left ventricle (LV). The optimal electrode position was selected by finding the smallest electrical dyssynchrony estimated by the duration of the QRS complex on electrocardiograms. We build the patient-specific anatomical model based on computer tomography (CT) of the torso, lungs and heart and accurate electrophysiology model for simulate electrocardiograms. The location of the right ventricle electrode was fixed and corresponded with original CT position. The position of the LV lead was varied and chosen in the center of one of the 17 segments on the subendocardial layer and subepicardial layer. The result of simulations has demonstrated the CRT effectivity can be improved by optimization of the LV electrode location by 10%.