Key result
An image fusion tool for echo-guided left ventricular lead placement achieved a registration accuracy of 4.3 ± 2.3 mm and matched echo-suggested segments in 20 of 21 CRT responders.
Why the study?
CRT response may improve if echocardiographic parameters guide LV lead placement, but tools visually integrating deformation imaging and fluoroscopy are lacking.
Does an image fusion tool integrating echocardiography and fluoroscopy facilitate targeted left ventricular lead placement in patients undergoing cardiac resynchronization therapy?
Observational (n=32)
Does an image fusion tool integrating echocardiography and fluoroscopy facilitate targeted left ventricular lead placement in patients undergoing cardiac resynchronization therapy?
A novel image fusion tool integrating echocardiography and fluoroscopy demonstrates clinically acceptable registration accuracy and time, potentially facilitating targeted left ventricular lead delivery in CRT.
Hypothesis-generating for image fusion-guided LV lead placement in CRT; prospective trials needed before adoption.
BACKGROUND: The response rate to cardiac resynchronization therapy (CRT) may be improved if echocardiographic-derived parameters are used to guide the left ventricular (LV) lead deployment. Tools to visually integrate deformation imaging and fluoroscopy to take advantage of the combined information are lacking. METHODS: An image fusion tool for echo-guided LV lead placement in CRT was developed. A personalized average 3D cardiac model aided visualization of patient-specific LV function in fluoroscopy. A set of coronary venography-derived landmarks facilitated registration of the 3D model with fluoroscopy into a single multimodality image. The fusion was both performed and analyzed retrospectively in 30 cases. Baseline time-to-peak values from echocardiography speckle-tracking radial strain traces were color-coded onto the fused LV. LV segments with suspected scar tissue were excluded by cardiac magnetic resonance imaging. The postoperative augmented image was used to investigate: (a) registration accuracy and (b) agreement between LV pacing lead location, echo-defined target segments, and CRT response. RESULTS: Registration time (264 ± 25 seconds) and accuracy (4.3 ± 2.3 mm) were found clinically acceptable. A good agreement between pacing location and echo-suggested segments was found in 20 (out of 21) CRT responders. Perioperative integration of the proposed workflow was successfully tested in 2 patients. No additional radiation, compared with the existing workflow, was required. CONCLUSIONS: The fusion tool facilitates understanding of the spatial relationship between the coronary veins and the LV function and may help targeted LV lead delivery.
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Babić et al. (2019) conducted an observational in Heart failure requiring cardiac resynchronization therapy (n=32). Image fusion tool for echo-guided left ventricular lead placement was evaluated on Registration accuracy and agreement between LV pacing lead location, echo-defined target segments, and CRT response. An image fusion tool for echo-guided left ventricular lead placement achieved a registration accuracy of 4.3 ± 2.3 mm and matched echo-suggested segments in 20 of 21 CRT responders.
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