On-screen image-guided lead placement in cardiac resynchronization therapy: Feasibility and outcome in a multicenter setting.

Autor:	Wouters PC; Department of Cardiology, UMC Utrecht, Utrecht, the Netherlands., van Slochteren FJ; Department of Cardiology, UMC Utrecht, Utrecht, the Netherlands.; CART-Tech BV, Utrecht, the Netherlands., Tuinenburg AE; Department of Cardiology, UMC Utrecht, Utrecht, the Netherlands., Doevendans PA; Department of Cardiology, UMC Utrecht, Utrecht, the Netherlands.; Netherlands Heart Institute, Utrecht, the Netherlands., Cramer MM; Department of Cardiology, UMC Utrecht, Utrecht, the Netherlands., Delnoy PHM; Department of Cardiology, Isala Hospital, Zwolle, the Netherlands., van Dijk VF; Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands., Meine M; Department of Cardiology, UMC Utrecht, Utrecht, the Netherlands.
Jazyk:	angličtina
Zdroj:	Heart rhythm O2 [Heart Rhythm O2] 2022 Oct 18; Vol. 4 (1), pp. 9-17. Date of Electronic Publication: 2022 Oct 18 (Print Publication: 2023).
DOI:	10.1016/j.hroo.2022.10.002
Abstrakt:	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). (© 2022 Heart Rhythm Society. Published by Elsevier Inc.)
Databáze:	MEDLINE
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