The VED meter — a new tool to measure the ventricular conduction abnormalities in heart failure patients

Heart failure patients with a left ventricular ejection fraction below or equal to 35%, QRS duration above 150 ms, and left bundle branch block (LBBB) are usually recommended for treatment with a cardiac resynchronization therapy (CRT) device. Yet, about one-third of these patients do not respond to CRT revealing the limit of the current patient management guidelines. For this reason, new methods for assessing the level of electrical ventricular delay (VED) are being explored. In this work, we present the VED Meter, autonomous software measuring the level of electrical activation delay from the standard body-surface electrocardiogram (ECG). The software delivers the VED parameter expressed in ms that reflects the electrical dyssynchrony between the right ventricle, septum and left ventricle lateral wall. We applied this software to the data from the MADIT-CRT trial to evaluate the VED values in three types of ventricular conduction disturbances: LBBB, right bundle branch block (RBBB), and intra-ventricular conduction disturbances (IVCD). We report that VED parameter has negative values for RBBB (delayed activation of the septum and the right ventricle) and positive for LBBB (delayed activation of the left ventricle lateral wall) which were significantly different at p<0.001.