Towards Real-Time Cardiac Resynchronization Therapy Guidance: Imageless ECGI Assessment of Ventricular Synchronization on LBBB Patients

Rubén Molero Alabau1, Marta Martínez Pérez2, Berta Pellicer Sendra3, Jana Reventós Presmanes4, Margarida Pujol Lopez5, Mariona Regany Closa5, Inés Martín6, Santiago Ros Dopico7, Roger Borràs5, Freddy Rainier Graterol5, Pablo Avila7, Esteban González Torrecilla7, Alejandro Carta7, Eduard Guasch5, Andreu M. Climent8, Ivo Roca Luque5, Felipe Atienza9, Jose Maria Tolosana5, Lluis Mont5, Maria de la Salud Guillem Sánchez8
1Corify Care SL, 2COR-Group, ITACA Institute, Universitat Politècnica de València, Valencia, Spain, 3Corify Care SL, Madrid, Spain, 4Arrhythmias Department, Hospital Clínic de Barcelona, 5Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Catalonia, Spain, 6IiSGM, Hospital General Universitario Gregorio Marañón, Spain, 7IiSGM, Hospital General Universitario Gregorio Marañón, Spain, 8Universitat Politècnica de València, 9Hospital General Universitario Gregorio Marañón (Cardiology Department)


Abstract

Introduction: Optimizing Cardiac Resynchronization Therapy (CRT) is hindered by ECG limitations and standard criteria in assessing ventricular synchronization during the procedure. Imageless Electrocardiographic Imaging (ECGI) offers a rapid, non-invasive method to assess ventricular synchronization by mapping local activation times (LAT) without requiring cardiac imaging. Purpose: This study aims to identify ECGI-derived metrics for determining effective ventricular resynchronization in left bundle branch block (LBBB) patients undergoing CRT. Methods: We evaluated an imageless ECGI system to quantify ventricular synchronization using Total Activation Time (TAT) and Ventricular Electrical Uncoupling (VEU) during CRT in 36 LBBB patients, compared to baseline LBBB state and 28 healthy controls. Results: CRT significantly reduced mean TAT (119±16 vs 77±15 ms, p<0.001) and VEU (45±10 vs 8±9 ms, p<0.001). Final CRT VEU was comparable to healthy controls (7±6 ms, p=NS), indicating restored interventricular synchrony. Conclusion: Imageless ECGI provides feasible, non-invasive TAT/VEU metrics, tracking CRT effects effectively and offering the potential for standardized, real-time guidance beyond subjective ECG interpretation.