Cardiac resynchronization therapy (CRT) is an effective treatment for patients with
symptomatic heart failure, reduced systolic left ventricular (LV) function, and QRS
delay.
1
Nevertheless, evidence continues to increase that the benefit of CRT can be improved
by positioning the LV lead remote from scar in an area of late electrical or mechanical
activation.
- Daubert J.C.
- Saxon L.
- Adamson P.B.
- et al.
European Heart Rhythm AssociationEuropean Society of CadriologyHeart Rhythm SocietyHeart Failure Society of AssociationAmerican Society of EchocardiographyHeart Failure Associtaion
2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management.
2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management.
Heart Rhythm. 2012; 9: 1524-1576
2
,
3
Numerous studies have emerged attempting to tackle this issue using variable modalities
to guide LV lead placement to a patient-specific site of late activation remote from
scar.
3
,
4
,
5
,
- Bakos Z.
- Markstad H.
- Ostenfeld E.
- Carlsson M.
- Roijer A.
- Borgquist R.
Combined preoperative information using a bullseye plot from speckle tracking echocardiography,
cardiac CT scan, and MRI scan: targeted left ventricular lead implantation in patients
receiving cardiac resynchronization therapy.
Eur Heart J Cardiovasc Imaging. 2014; 15: 523-531
6
,
- Shetty A.K.
- Duckett S.G.
- Ginks M.R.
- et al.
Cardiac magnetic resonance-derived anatomy, scar, and dyssynchrony fused with fluoroscopy
to guide LV lead placement in cardiac resynchronization therapy: a comparison with
acute haemodynamic measures and echocardiographic reverse remodelling.
Eur Heart J Cardiovasc Imaging. 2013; 14: 692-699
7
,
8
Delayed enhancement cardiac magnetic resonance imaging (DE-CMR) remains the criterion
standard for myocardial scar assessment. Accordingly, this modality is predominantly
used to guide LV lead placement outside scar in most of the aforementioned studies.To read this article in full you will need to make a payment
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References
- 2012 EHRA/HRS expert consensus statement on cardiac resynchronization therapy in heart failure: implant and follow-up recommendations and management.Heart Rhythm. 2012; 9: 1524-1576
- QRS morphology, left ventricular lead location, and clinical outcome in patients receiving cardiac resynchronization therapy.Eur Heart J. 2013; 34: 2252-2262
- Targeted left ventricular lead placement to guide cardiac resynchronization therapy: the TARGET study: a randomized, controlled trial.J Am Coll Cardiol. 2012; 59: 1509-1518
- 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.Heart Rhythm. 2017; 14: 110-119
- Combined preoperative information using a bullseye plot from speckle tracking echocardiography, cardiac CT scan, and MRI scan: targeted left ventricular lead implantation in patients receiving cardiac resynchronization therapy.Eur Heart J Cardiovasc Imaging. 2014; 15: 523-531
- Cardiac magnetic resonance-derived anatomy, scar, and dyssynchrony fused with fluoroscopy to guide LV lead placement in cardiac resynchronization therapy: a comparison with acute haemodynamic measures and echocardiographic reverse remodelling.Eur Heart J Cardiovasc Imaging. 2013; 14: 692-699
- Left ventricular lead placement in the latest activated region guided by coronary venous electroanatomic mapping.Europace. 2015; 17: 84-93
- Model-based navigation of left and right ventricular leads to optimal targets for cardiac resynchronization therapy: a single-center feasibility study.Circ Arrhythm Electrophysiol. 2014; 7: 1040-1047
- Compresensive use of cardiac computed tomograpy to guide left ventricular lead placement in cardiac resynchronization therapy.Heart Rhythm. 2017; 14: 1364-1372
- Correlation of CT-based regional cardiac function (SQUEEZ) with myocardial strain calculated from tagged MRI: an experimental study.Int J Cardiovasc Imaging. 2016; 32: 817-823
- Different regions of latest electrical activation during left bundle-branch block and right ventricular pacing in cardiac resynchronization therapy patients determined by coronary venous electro-anatomic mapping.Eur J Heart Fail. 2014; 16: 1214-1222
- Further deterioration of LV ejection fraction and mechanical synchrony during RV apical pacing in patients with heart failure and LBBB.J Cardiovasc Transl Res. 2013; 6: 425-429
- New insights from a computational model on the relation between pacing site and CRT response.Europace. 2016; 18: iv94-iv103
Article info
Publication history
Published online: May 23, 2017
Footnotes
Dr Prinzen has received research grants from Medtronic, St. Jude Medical, Sorin, MSD, and Biotronik. Dr Vernooy has received research grants from Medtronic and St. Jude Medical.
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© 2017 Heart Rhythm Society. All rights reserved.
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- Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapyHeart RhythmVol. 14Issue 9Open Access
