Use of body-surface potential mapping and computer model simulations for optimal programming of cardiac resynchronization therapy devices

It has been proposed that by optimizing the timing of activation between the ventricles (V-V interval), with the aid of body-surface potential mapping (BSPM), the success rate of cardiac resynchronization therapy (CRT) devices could be improved. We recorded 120-electrode BSPM data and CT scans from two patients with implanted CRT devices and calculated, by means of electrocardiographic inverse solution, epicardial potentials and isochrones of activation for different V-V intervals. To gain better insight, we used a computer model of ventricular activation to simulate activation isochrones for CRT pacing. As a measure of inter-ventricular synchrony for a variety of V-V settings we used the area between the LV and RV percent surface activated curves. We have demonstrated that by aiming to minimize dyssynchrony in ventricular activation patterns, an optimal CRT pacing V-V interval can be selected. The computer model simulations provided a baseline measure by which our measure of synchrony can be evaluated.