Aim. This study introduces a state-of-the-art real-time non-invasive mapping system tailored to enhance Cardiac Resynchronization Therapy (CRT). By integrating of fast generation fully automated noninvasive electroanatomical map (EAM) the system facilitates optimal LV lead placement and individualized pacing modes aligning with the patient-specific cardiac electrophysiology data captured during the CRT implantation and optimization procedure.
Methods. This system is based on the latest development of a noninvasive EAM system using a 12-lead ECG integrated with automatic cardiac computer tomography (CT) segmentation algorithms from 150 patients in CRT-ROADMAP clinical study. It introduces several innovative electrophysiological tools in the form of a cross-platform desktop application suitable for use within the secure internal network of clinics. Specifically, the system is designed to cover the entire pipeline of CRT implantation which includes interactive 3D visualization of cardiac anatomy with EAM and now provides the capability to perform simulations at the pre-implantation stage as well as offering a post-implantation decision support system that generates stimulated EAM and conducts statistical analysis at the follow-up stage. Validation took place in the Catheter Lab during 5 live CRT procedures to create panoramic epi-endocardial EAMs, optimize LV lead placement and immediately adjust pacing modes post-implantation.
Results. Our findings indicate that the real-time EAM system can significantly refine the precision of LV electrode placement during CRT implantations. The system computes maps within 3 minutes for initial ECGs and under 10 seconds for subsequent analyses which allow for immediate adjustments based on patient-specific cardiac anatomy and electrophysiology.
Conclusions. The introduction of real-time non-invasive mapping represents a breakthrough in cardiac diagnostics providing clinicians with a powerful tool for dynamic procedural guidance. This technology enhances the effectiveness of CRT and other electrophysiology procedures by ensuring optimal intervention strategies are employed based on real-time data while clinicians are empowered to make immediate intra-procedural adjustments.