A novel approach for left ventricular lead placement in cardiac resynchronization therapy: Intraprocedural integration of coronary venous electroanatomic mapping with delayed enhancement cardiac magnetic resonance imaging

详细信息    查看全文

• 作者：Uyê ; n Châ ; u Nguyê ; n ; MD ; MSc^⁎ ; ^{chau27@gmail.com} ; Masih Mafi-Rad ; MD ; PhD^&dagger ; ; Jean-Paul Aben ; BSc^&Dagger ; ; Martijn W. Smulders ; MD^&dagger ; ; Elien B. Engels ; PhD^⁎ ; Antonius M.W. van Stipdonk ; MD^&dagger ; ; Justin G.L.M. Luermans ; MD ; PhD^&dagger ; ; Sebastiaan C.A.M. Bekkers ; MD ; PhD^&dagger ; ; Frits W. Prinzen ; PhD^⁎ ; Kevin Vernooy ; MD ; PhD^&dagger ;
• 关键词：Cardiac resynchronization therapy ; Left ventricular lead placement ; Electroanatomic mapping ; Delayed enhancement cardiac magnetic resonance
• 刊名：Heart Rhythm
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：14
• 期：1
• 页码：110-119
• 全文大小：2423 K
• 卷排序：14

文摘

Placing the left ventricular (LV) lead at a site of late electrical activation remote from scar is desired to improve cardiac resynchronization therapy (CRT) response.ObjectiveThe purpose of this study was to integrate coronary venous electroanatomic mapping (EAM) with delayed enhancement cardiac magnetic resonance (DE-CMR) enabling LV lead guidance to the latest activated vein remote from scar.MethodsEighteen CRT candidates with focal scar on DE-CMR were prospectively included. DE-CMR images were semi-automatically analyzed. Coronary venous EAM was performed intraprocedurally and integrated with DE-CMR to guide LV lead placement in real time. Image integration accuracy and electrogram parameters were evaluated offline.ResultsIntegration of EAM and DE-CMR was achieved using 8.9 ± 2.8 anatomic landmarks and with accuracy of 4.7 ± 1.1 mm (mean ± SD). Maximal electrical delay ranged between 72 and 197ms (57%−113% of QRS duration) and was heterogeneously located among individuals. In 12 patients, the latest activated vein was located outside scar, and placing the LV lead in the latest activated vein remote from scar was accomplished in 10 patients and prohibited in 2 patients. In the other 6 patients, the latest activated vein was located in scar, and targeting alternative veins was considered. Unipolar voltages were on average lower in scar compared to nonscar (6.71 ± 3.45 mV vs 8.18 ± 4.02 mV [median ± interquartile range), P <.001) but correlated weakly with DE-CMR scar extent (R –0.161, P <.001) and varied widely among individual patients.ConclusionIntegration of coronary venous EAM with DE-CMR can be used during CRT implantation to guide LV lead placement to the latest activated vein remote from scar, possibly improving CRT.