Integration of cardiac magnetic resonance imaging, electrocardiographic imaging, and coronary venous computed tomography angiography for guidance of left ventricular lead positioning.
Europace
; 21(4): 626-635, 2019 Apr 01.
Article
en En
| MEDLINE
| ID: mdl-30590434
ABSTRACT
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 ANDRESULTS:
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.Palabras clave
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Angiografía Coronaria
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Mapeo del Potencial de Superficie Corporal
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Imagen por Resonancia Cinemagnética
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Implantación de Prótesis
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Dispositivos de Terapia de Resincronización Cardíaca
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Angiografía por Tomografía Computarizada
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Trastorno del Sistema de Conducción Cardíaco
Tipo de estudio:
Guideline
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Observational_studies
Límite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Año:
2019
Tipo del documento:
Article