Key result
Image-guided techniques such as echocardiography, CMR, and nuclear imaging can identify optimal left ventricular lead positions to improve cardiac resynchronisation therapy response rates.
Image-guided LV lead placement using multimodality imaging shows potential to improve CRT response rates by targeting viable, late-activating myocardium, though large-scale validation is needed.
May support image-guided LV lead placement in CRT; leaves open need for large RCTs before practice change.
Cardiac resynchronisation therapy (CRT) is a standard treatment for patients with heart failure; however, the low response rate significantly reduces its cost-effectiveness. A favourable CRT response primarily depends on whether implanters can identify the optimal left ventricular (LV) lead position and accurately place the lead at the recommended site. Myocardial imaging techniques, including echocardiography, cardiac magnetic resonance imaging and nuclear imaging, have been used to assess LV myocardial viability and mechanical dyssynchrony, and deduce the optimal LV lead position. The optimal position, presented as a segment of the myocardial wall, is then overlaid with images of the coronary veins from fluoroscopy to aid navigation of the LV lead to the target venous site. Once validated by large clinical trials, these image-guided techniques for CRT lead placement may have an impact on current clinical practice.
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Tang et al. (2017) conducted a review in Heart failure. Image-guided left ventricular lead placement vs. Standard/routine CRT lead placement was evaluated. Image-guided techniques such as echocardiography, CMR, and nuclear imaging can identify optimal left ventricular lead positions to improve cardiac resynchronisation therapy response rates.
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