Identifying people at risk of arrhythmias after cardiac resynchronisation therapy

The role of scar morphology and location in arrhythmogenic risk following cardiac resynchronization therapy in patients with ischemic heart disease

Dr Steven Niederer and his team at King’s College London are working out why some people develop heart rhythm problems, or arrhythmias, after they receive cardiac resynchronisation therapy (CRT). CRT is used to treat heart failure, but it also increases the risk of arrhythmias in some people. We don’t understand why this happens, and currently doctors are not able to detect those at risk. Arrhythmias happen when the heart’s regular electrical activity is disturbed, and if not treated quickly can be fatal. Most people who experience arrhythmias have scarred heart tissue, and the arrhythmia usually starts near this scarring. CRT pacemaker devices change the direction from which the heart’s electrical activation wave hits the scar, and this could either increase or reduce the risk of arrhythmia. In this project, Dr Niederer will combine detailed heart imaging and electrical measurements from patients to develop computer models of the electric activity in the heart. These models will be used to investigate if CRT alters the electrical activity of the heart tissue where the tissue is scarred, and whether or not these changes can predict which patients are likely to develop arrhythmias. The computer model could be used to predict which patients are at risk of developing arrhythmia after CRT, so their treatment, for instance, the placement of the CRT leads, can be adapted to avoid this complication.