TY - JOUR
T1 - On-Screen Image-Guided Lead Placement in Cardiac Resynchronization Therapy
T2 - Feasibility and Outcome in a Multicenter Setting
AU - Wouters, Philippe C.
AU - van Slochteren, Frebus J.
AU - Tuinenburg, Anton E.
AU - Doevendans, Pieter A.
AU - Cramer, Maarten Jan M.
AU - Delnoy, Peter Paul H.M.
AU - van Dijk, Vincent F.
AU - Meine, Mathias
N1 - Funding Information:
The authors have no funding sources to disclose. Dr van Slochteren is cofounder, chief technical officer, and shareholder of CART-Tech BV. Drs Meine and van Slochteren are inventors and beneficiaries of a patent license arrangement between the University Medical Center Utrecht and CART-Tech BV according to the rules of the University Medical Center Utrecht. All authors attest they meet the current ICMJE criteria for authorship. All patients gave written informed consent. The trial was registered at the Netherlands Trial Register (Trial NL8506) and approved by the Medical Research Ethics Committee Utrecht. The research reported in this paper adhered to the Helsinki Declaration guidelines.
Publisher Copyright:
© 2022 Heart Rhythm Society
PY - 2023/1
Y1 - 2023/1
N2 - Background: Image guidance to assist left ventricular (LV) lead placement may improve outcome after cardiac resynchronization therapy (CRT), but previous approaches and results varied greatly, and multicenter feasibility is lacking altogether. Objective: We sought to investigate the multicenter feasibility of image guidance for periprocedural assistance of LV lead placement for CRT. Methods: In 30 patients from 3 hospitals, cardiac magnetic resonance imaging was performed within 3 months prior to CRT to identify myocardial scar and late mechanical activation (LMA). LMA was determined using radial strain, plotted over time. Segments without scar but clear LMA were classified as optimal for LV lead placement, according to an accurate 36-segment model of the whole heart. LV leads were navigated using image overlay with periprocedural fluoroscopy. After 6 months, volumetric response and super-response were defined as ≥15% or ≥30% reduction in LV end-systolic volume, respectively. Results: Periprocedural image guidance was successfully performed in all CRT patients (age 66 ± 10 years; 59% men, 62% with nonischemic cardiomyopathy, 69% with left bundle branch block). LV leads were placed as follows: within (14%), adjacent (62%), or remote (24%) from the predefined target. According to the conventional 18-segment model, a remote position occurred only once (3%). On average, 86% of patients demonstrated a volumetric response (mean LV end-systolic volume reduction 36 ± 29%), and 66% of all patients were super-responders. Conclusion: On-screen image guidance for LV lead placement in CRT was feasible in a multicenter setting. Efficacy will be further investigated in the randomized controlled ADVISE (Advanced Image Supported Lead Placement in Cardiac Resynchronization Therapy) trial (NCT05053568).
AB - Background: Image guidance to assist left ventricular (LV) lead placement may improve outcome after cardiac resynchronization therapy (CRT), but previous approaches and results varied greatly, and multicenter feasibility is lacking altogether. Objective: We sought to investigate the multicenter feasibility of image guidance for periprocedural assistance of LV lead placement for CRT. Methods: In 30 patients from 3 hospitals, cardiac magnetic resonance imaging was performed within 3 months prior to CRT to identify myocardial scar and late mechanical activation (LMA). LMA was determined using radial strain, plotted over time. Segments without scar but clear LMA were classified as optimal for LV lead placement, according to an accurate 36-segment model of the whole heart. LV leads were navigated using image overlay with periprocedural fluoroscopy. After 6 months, volumetric response and super-response were defined as ≥15% or ≥30% reduction in LV end-systolic volume, respectively. Results: Periprocedural image guidance was successfully performed in all CRT patients (age 66 ± 10 years; 59% men, 62% with nonischemic cardiomyopathy, 69% with left bundle branch block). LV leads were placed as follows: within (14%), adjacent (62%), or remote (24%) from the predefined target. According to the conventional 18-segment model, a remote position occurred only once (3%). On average, 86% of patients demonstrated a volumetric response (mean LV end-systolic volume reduction 36 ± 29%), and 66% of all patients were super-responders. Conclusion: On-screen image guidance for LV lead placement in CRT was feasible in a multicenter setting. Efficacy will be further investigated in the randomized controlled ADVISE (Advanced Image Supported Lead Placement in Cardiac Resynchronization Therapy) trial (NCT05053568).
KW - Cardiac resynchronization therapy
KW - Heart failure
KW - Image guidance
KW - Image overlay
KW - Magnetic resonance imaging
UR - http://www.scopus.com/inward/record.url?scp=85142736005&partnerID=8YFLogxK
U2 - 10.1016/j.hroo.2022.10.002
DO - 10.1016/j.hroo.2022.10.002
M3 - Article
C2 - 36713038
AN - SCOPUS:85142736005
VL - 4
SP - 9
EP - 17
JO - Heart Rhythm O2
JF - Heart Rhythm O2
IS - 1
ER -