Abstract
Aims An appropriate left ventricular (LV) lead position is a pre-requisite for response to cardiac resynchronization therapy (CRT) and is highly patient-specific. The purpose of this study was to develop a non-invasive pre-procedural CRT-roadmap to guide LV lead placement to a coronary vein in late-activated myocardium remote from scar.
Methods and results Sixteen CRT candidates were prospectively included. Electrocardiographic imaging (ECGI), computed tomography angiography (CTA), and delayed enhancement cardiac magnetic resonance imaging (DE-CMR) were integrated into a 3D cardiac model (CRT-roadmap) using anatomic landmarks from CTA and DE-CMR. Electrocardiographic imaging was performed using 184 electrodes and a CT-based heart-torso geometry. Coronary venous anatomy was visualized using a designated CTA protocol. Focal scar was assessed from DE-CMR. Cardiac resynchronization therapy-roadmaps were constructed for all 16 patients [left bundle branch block: n=6; intraventricular conduction disturbance: n=8; narrow-QRS (ablate and pace strategy); n=1; right bundle branch block: n=1]. The number of coronary veins ranged between 3 and 4 per patient. The CRT-roadmaps showed no (n=5), 1 (n=6), or 2 (n=5) veins per patient located outside scar in late-activated myocardium [50% QRS duration (QRSd)]. Final LV lead position was outside scar in late-activated myocardium in 11 out of 14 implanted patients, while a LV lead in scar was unavoidable in the remaining three patients.
Conclusion A non-invasive pre-implantation CRT-roadmap was feasible to develop in a case series by integration of coronary venous anatomy, myocardial-scar localization, and epicardial electrical activation patterns, anticipating on clinically relevant features.
Original language | English |
---|---|
Pages (from-to) | 626-635 |
Number of pages | 10 |
Journal | EP Europace |
Volume | 21 |
Issue number | 4 |
DOIs | |
Publication status | Published - Apr 2019 |
Keywords
- Cardiac resynchronization therapy
- Left ventricular lead
- Image integration
- Coronary venous anatomy
- Computed tomography angiography
- Electrocardiographic imaging
- Cardiac magnetic resonance imaging
- Myocardial scar
- Heart failure
- RESYNCHRONIZATION THERAPY
- PLACEMENT
- CT
- ECHOCARDIOGRAPHY
- RADIATION
- MODEL