Reproducibility and repeatability of identifying latest electrical
activation during mapping of coronary sinus branches in CRT recipients
Abstract
Introduction: Studies have shown an association between outcome in
cardiac resynchronization therapy (CRT) and longer interventricular
delay at the site of the left ventricular (LV) lead. Targeted LV lead
placement at the latest electrically activated segment increases LV
function further as compared with standard treatment. We aimed to
determine reproducibility and repeatability of identifying latest
electrically activated segment during mapping of all available CS
branches in patients receiving CRT. Methods: We included 35 patients who
underwent CRT implantation with protocolled mapping guided LV lead
implantation aiming for the site of latest electrical activation. Three
different doctors experienced in electrophysiology and implantation of
CRT devices independently measured time interval from the local bipolar
right ventricular (RV) electrogram (EGM) to the local unipolar LV EGM at
all mapped sites (RV-LV). The segment with the latest electrical
activation was defined as target segment (TS) and the CS tributary
containing TS was defined as target vein (TV). Weighted Kappa statistics
with 95% confidence intervals were computed to assess intra-and
inter-observer agreement for TS and TV. Results: We mapped 258 segments
within 131 veins. Weighted kappa values for repeatability were 0.85
(0.81-0.89) for TS and 0.92 (0.89-0.93) for TV, and weighted kappa
values of inter-observer agreement ranged from 0.70 (0.61-0.73) to 0.80
(0.76-0.83) for TS and 0.73 (0.64-0.78) to 0.86 (0.83-0.89) for TV among
all three observers. Conclusion: The reproducibility and repeatability
of identifying latest electrically activated segment during mapping of
all available CS branches in patients receiving CRT ranges from good to
very good.