PO-02-021 DIRECTION OF REPOLARIZATION IN BASELINE ECG IS PREDICTIVE OF RESPONSE TO CARDIAC RESYNCHRONIZATION THERAPY

Cardiac resynchronization therapy (CRT) is a cornerstone of treatment for advanced heart failure, but not all patients derive equal benefit from this intervention. Current approaches using electrocardiographic and echocardiographic parameters to identify likely CRT responders demonstrate poor predictive ability. We seek that can improve prediction with This was retrospective analysis who underwent CRT-D placement at University Pittsburgh Medical Center 2014-2020. Patients were excluded if pre-implantation EKG or pre- post-implantation echocardiograms available. Each patient’s immediate ECG processed the CineECG software (EKG Excellence) obtain mean temporospatial isochrone ventricular activation. 192 features quantifying activation recovery pathways computed each patient. Response defined as an improvement in ejection fraction (EF) 5% on follow-up transthoracic echocardiogram 3-12 months after implantation. Forward sequential feature selection used highest importance based negative logistic loss. 276 included (36% female, age 69 years, pre-procedural EF 27%). The 10 most important identified. When these multivariate regression, three independently response: left bundle branch block (LBBB); leftward direction late repolarization potentials (i.e., Tpeak - Tend rotated toward LV horizontal plane); location center-of-mass terminal cardiac Compared (n=169, 62%), non-responders more have abnormal both LBBB group (-0.34±0.30 vs. -0.45±0.30 vs, p=0.027) RBBB (0.25±0.51 0.61±0.27, p=0.031). In latter group, later correlated magnitude change post-procedural (r=0.23, p=0.016). Our findings confirm presence response CRT. addition, our data suggests RBBB, response. Further studies into dynamics predictor are warranted.