Key result
QLV-guided LV lead placement achieves ~75% concordance with echo targeting but prolongs procedure times.
Why the study?
Echocardiographic guidance to target latest mechanical activation improves CRT outcomes but increases resource utilisation, whereas measuring QLV might provide an alternative electrical marker.
Does intra-procedural QLV measurement provide a concordant target for LV lead placement compared to speckle-tracking echocardiography in patients with heart failure undergoing CRT?
Observational (n=22)
Single-blind
No
Does intra-procedural QLV measurement provide a concordant target for LV lead placement compared to speckle-tracking echocardiography in patients with heart failure undergoing CRT?
Effect estimate: Cohen's κ 0.476
Intra-procedural QLV mapping is a feasible alternative to echocardiography for guiding LV lead placement in CRT, demonstrating moderate agreement but requiring longer procedure times.
QLV mapping shows moderate concordance with echo for CRT lead placement; leaves open whether added procedural time is justified pending outcome trials.
Introduction: Cardiac resynchronisation therapy is ineffective in 30–40% of patients with heart failure with reduced ejection fraction. Targeting non-scarred myocardium by selecting the site of latest mechanical activation using echocardiography has been suggested to improve outcomes but at the cost of increased resource utilisation. The interval between the beginning of the QRS complex and the local LV lead electrogram (QLV) might represent an alternative electrical marker. Aims: To determine whether the site of latest myocardial electrical and mechanical activation are concordant. Methods: This was a single-centre, prospective pilot study, enrolling patients between March 2019 and June 2021. Patients underwent speckle-tracking echocardiography (STE) prior to CRT implantation. Intra-procedural QLV measurement and R-wave amplitude were performed in a blinded fashion at all accessible coronary sinus branches. Pearson’s correlation coefficient and Cohen’s Kappa coefficient were utilised for the comparison of electrical and echocardiographic parameters. Results: A total of 20 subjects had complete data sets. In 15, there was a concordance at the optimal site between the electrically targeted region and the mechanically targeted region; in four, the regions were adjacent (within one segment). There was discordance (≥2 segments away) in only one case between the two methods of targeting. There was a statistically significant increase in procedure time and fluoroscopy duration using the intraprocedural QLV strategy. There was no statistical correlation between the quantitative electrical and echocardiographic data. Conclusions: A QLV-guided approach to targeting LV lead placement appears to be a potential alternative to the established echocardiographic-guided technique. However, it is associated with prolonged fluoroscopy and overall procedure time.
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Chousou et al. (2024) conducted an observational in Heart failure with reduced ejection fraction and LBBB (n=22). Intraprocedural QLV (electrical) measurement for LV lead targeting vs. Speckle-tracking echocardiography (mechanical) measurement was evaluated on Concordance between the site of latest myocardial electrical and mechanical activation (Cohen's κ 0.476). A QLV-guided approach demonstrated 75% agreement (Cohen's κ 0.476) with echo-guided targeting for optimal LV lead placement, but significantly prolonged procedure and fluoroscopy times.
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