Electrocardiogram Belt guidance for left ventricular lead placement and biventricular pacing optimization

Published:November 25, 2022DOI:


      Patients with ischemic cardiomyopathy, non–left bundle branch block, or QRS duration <150 ms have a lower response rate to cardiac resynchronization therapy (CRT) than did other indicated patients. The ECG Belt system (EBS) is a novel surface mapping system designed to measure electrical dyssynchrony via the standard deviation of the activation times of the left ventricle.


      The objectives of this study were to evaluate the efficacy of the EBS in patients less likely to respond to CRT and to determine whether EBS use in lead placement guidance and device programming was superior to standard CRT care.


      This was a prospective randomized trial of patients with heart failure and EBS-guided CRT implantation and programming vs standard CRT care. The primary end point was relative change in left ventricular end-systolic volume from baseline to 6 months postimplantation.


      A total of 408 subjects from centers in Europe and North America were randomized. Although both patients with EBS and control patients had a mean improvement in left ventricular end-systolic volume, there was no significant difference in relative change from baseline (P = .26). While patients with a higher baseline standard deviation of the activation times derived greater left ventricular reverse remodeling, improvement in electrical dyssynchrony did not correlate with the extent of reverse remodeling.


      The findings of the present study do not support EBS-guided therapy for CRT management of heart failure with reduced ejection fraction.


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      Linked Article

      • Electrocardiogram Belt system: Opportunity for optimization?
        Heart Rhythm
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          The development and implementation of biventricular pacing or cardiac resynchronization therapy (CRT) for heart failure over the past several decades have been a remarkable technological and therapeutic advancement. Initial reports of multisite pacing for heart failure initially epicardial, then endocardial in observational studies progressed to a rapid expansion in the demonstration of benefits of CRT in clinical trials.1–4 In 2001, the first commercially available CRT pacemaker became available in the United States, and soon thereafter, CRT within an implantable cardiac defibrillator was also available.
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