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Synchronization of repolarization after cardiac resynchronization therapy: a combined clinical and modeling study
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  • Nienke J. Verzaal,
  • Caroline J.M. van Deursen,
  • Simone Pezzuto,
  • Liliane Wecke,
  • Wouter M. van Everdingen,
  • Kevin Vernooy,
  • Tammo Delhaas,
  • Angelo Auricchio,
  • Frits Prinzen
Nienke J. Verzaal
Universiteit Maastricht Cardiovascular Research Institute Maastricht

Corresponding Author:n.verzaal@maastrichtuniversity.nl

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Caroline J.M. van Deursen
Maastricht Universitair Medisch Centrum+
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Simone Pezzuto
Universita della Svizzera italiana
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Liliane Wecke
Capio Sankt Gorans Sjukhus
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Wouter M. van Everdingen
Radboudumc Afdeling Radiologie en nucleaire beeldvorming
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Kevin Vernooy
Maastricht Universitair Medisch Centrum+
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Tammo Delhaas
Universiteit Maastricht Cardiovascular Research Institute Maastricht
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Angelo Auricchio
Universita della Svizzera italiana
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Frits Prinzen
Universiteit Maastricht Cardiovascular Research Institute Maastricht
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Abstract

Background: The changes in ventricular repolarization after cardiac resynchronization therapy (CRT) are poorly understood. Objective: Address this knowledge gap using a multimodality approach including electrocardiographic and echocardiographic measurements in patients and using patient-specific computational modeling. Methods: In 33 patients electrocardiographic and echocardiographic measurements were performed before and at various intervals after CRT, both during CRT-ON and temporary CRT-OFF. T-wave area was calculated from vectorcardiograms, reconstructed from the 12-lead ECG. Computer simulations were performed using a patient-specific eikonal model of cardiac activation with spatially varying action potential duration (APD) and repolarization rate, fit to a patient’s ECG. Results: During CRT-ON T-wave area diminished within a day and remained stable thereafter, whereas QT-interval did not change significantly. During CRT-OFF T-wave area doubled within 5 days of CRT, while QT-interval and peak-to-end T-wave interval hardly changed. Left ventricular (LV) ejection fraction did not significantly increase before 1 month of CRT. Computer simulations indicated that the increase in T-wave area during CRT-OFF can be explained by changes in APD following chronic CRT that are opposite to the change in CRT-induced activation time. These APD changes were associated with a reduction in LV dispersion in repolarization during chronic CRT. Conclusions: T-wave area during CRT-OFF is a sensitive marker for adaptations in ventricular repolarization during chronic CRT that may include a reduction in LV dispersion of repolarization.
10 Mar 2022Submitted to Journal of Cardiovascular Electrophysiology
10 Mar 2022Submission Checks Completed
10 Mar 2022Assigned to Editor
17 Mar 2022Reviewer(s) Assigned
16 May 2022Review(s) Completed, Editorial Evaluation Pending
19 May 2022Editorial Decision: Revise Minor
20 May 20221st Revision Received
28 May 2022Submission Checks Completed
28 May 2022Assigned to Editor
28 May 2022Reviewer(s) Assigned
29 May 2022Review(s) Completed, Editorial Evaluation Pending
30 May 2022Editorial Decision: Accept
11 Jun 2022Published in Journal of Cardiovascular Electrophysiology. 10.1111/jce.15581