TY - JOUR
T1 - A novel approach for left ventricular lead placement in cardiac resynchronization therapy
T2 - Intraprocedural integration of coronary venous electroanatomic mapping with delayed enhancement cardiac magnetic resonance imaging
AU - Uyen Chau Nguyen, [No Value]
AU - Mafi-Rad, Masih
AU - Aben, Jean-Paul
AU - Smulders, Martijn W.
AU - Engels, Elien B.
AU - van Stipdonk, Antonius M. W.
AU - Luermans, Justin G. L. M.
AU - Bekkers, Sebastiaan C. A. M.
AU - Prinzen, Frits W.
AU - Vernooy, Kevin
PY - 2017/1
Y1 - 2017/1
N2 - BACKGROUND: Placing the left ventricular (LV) lead at a site of late electrical activation remote from scar is desired to improve cardiac resynchronization therapy (CRT) response. OBJECTIVE: The purpose of this study was to integrate coronary venous electroanatomic mapping (EAM) with delayed enhancement cardiac magnetic resonance (DE-CMR) enabling LV lead guidance to the latest activated vein remote from scar.METHODS: Eighteen CRT candidates with focal scar on DE-CMR were prospectively included. DE-CMR images were semi-automatically analyzed. Coronary venous EAM was performed intraprocedurally and integrated with DE-CMR to guide LV lead placement in real time. Image integration accuracy and electrogram parameters were evaluated offline.RESULTS: Integration of EAM and DE-CMR was achieved using 8.9 +/- 2.8 anatomic landmarks and with accuracy of 4.7 +/- 1.1 mm (mean +/- SD). Maximal electrical delay ranged between 72 and 197ms (57%-113% of QRS duration) and was heterogeneously located among individuals. In 12 patients, the latest activated vein was located outside scar, and placing the LV lead in the latest activated vein remote from scar was accomplished in 10 patients and prohibited in 2 patients. In the other 6 patients, the latest activated vein was located in scar, and targeting alternative veins was considered. Unipolar voltages were on average lower in scar compared to nonscar (6.71 +/- 3.45 mV vs 8.18 +/- 4.02 mV [median +/- interquartile range), PCONCLUSION: Integration of coronary venous EAM with DE-CMR can be used during CRT implantation to guide LV lead placement to the latest activated vein remote from scar, possibly improving CRT.
AB - BACKGROUND: Placing the left ventricular (LV) lead at a site of late electrical activation remote from scar is desired to improve cardiac resynchronization therapy (CRT) response. OBJECTIVE: The purpose of this study was to integrate coronary venous electroanatomic mapping (EAM) with delayed enhancement cardiac magnetic resonance (DE-CMR) enabling LV lead guidance to the latest activated vein remote from scar.METHODS: Eighteen CRT candidates with focal scar on DE-CMR were prospectively included. DE-CMR images were semi-automatically analyzed. Coronary venous EAM was performed intraprocedurally and integrated with DE-CMR to guide LV lead placement in real time. Image integration accuracy and electrogram parameters were evaluated offline.RESULTS: Integration of EAM and DE-CMR was achieved using 8.9 +/- 2.8 anatomic landmarks and with accuracy of 4.7 +/- 1.1 mm (mean +/- SD). Maximal electrical delay ranged between 72 and 197ms (57%-113% of QRS duration) and was heterogeneously located among individuals. In 12 patients, the latest activated vein was located outside scar, and placing the LV lead in the latest activated vein remote from scar was accomplished in 10 patients and prohibited in 2 patients. In the other 6 patients, the latest activated vein was located in scar, and targeting alternative veins was considered. Unipolar voltages were on average lower in scar compared to nonscar (6.71 +/- 3.45 mV vs 8.18 +/- 4.02 mV [median +/- interquartile range), PCONCLUSION: Integration of coronary venous EAM with DE-CMR can be used during CRT implantation to guide LV lead placement to the latest activated vein remote from scar, possibly improving CRT.
KW - Cardiac resynchronization therapy
KW - Leftventricular lead placement
KW - Electroanatomic mapping
KW - Delayed enhancement cardiac magnetic resonance
KW - SCAR
KW - LOCATION
KW - MODEL
U2 - 10.1016/j.hrthm.2016.09.015
DO - 10.1016/j.hrthm.2016.09.015
M3 - Article
C2 - 27663606
SN - 1547-5271
VL - 14
SP - 110
EP - 119
JO - Heart Rhythm
JF - Heart Rhythm
IS - 1
ER -