A non-invasive pre-implantation CRT-roadmap was feasible to develop, resulting in final LV lead placement outside scar in late-activated myocardium in 11 of 14 implanted patients (78.6%).
Observational (n=16)
Does a non-invasive pre-procedural CRT-roadmap integrating ECGI, CTA, and DE-CMR help guide LV lead placement to a coronary vein in late-activated myocardium remote from scar in CRT candidates?
A non-invasive pre-implantation CRT-roadmap integrating ECGI, CTA, and DE-CMR is feasible for guiding LV lead placement to optimal coronary veins outside of scar tissue.
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.
Nguyên et al. (Mon,) conducted a observational in Cardiac resynchronization therapy candidates (n=16). Non-invasive pre-procedural CRT-roadmap was evaluated on Final LV lead position outside scar in late-activated myocardium. A non-invasive pre-implantation CRT-roadmap was feasible to develop, resulting in final LV lead placement outside scar in late-activated myocardium in 11 of 14 implanted patients (78.6%).