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Left ventricular lead positioning in cardiac resynchronization therapy: Mission accomplished?

  • Uyên Châu Nguyên
    Affiliations
    Department of Physiology, Maastricht University Medical Center, Maastricht, The Netherlands

    Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
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  • Frits W. Prinzen
    Affiliations
    Department of Physiology, Maastricht University Medical Center, Maastricht, The Netherlands
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  • Kevin Vernooy
    Correspondence
    Address reprint requests and correspondence: Dr Kevin Vernooy, Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
    Affiliations
    Department of Physiology, Maastricht University Medical Center, Maastricht, The Netherlands

    Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
    Search for articles by this author
      Cardiac resynchronization therapy (CRT) is an effective treatment for patients with symptomatic heart failure, reduced systolic left ventricular (LV) function, and QRS delay.
      • 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.
      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.
      • Kandala J.
      • Upadhyay G.A.
      • Altman R.K.
      • et al.
      QRS morphology, left ventricular lead location, and clinical outcome in patients receiving cardiac resynchronization therapy.
      • Khan F.Z.
      • Virdee M.S.
      • Palmer C.R.
      • et al.
      Targeted left ventricular lead placement to guide cardiac resynchronization therapy: the TARGET study: a randomized, controlled trial.
      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.
      • Khan F.Z.
      • Virdee M.S.
      • Palmer C.R.
      • et al.
      Targeted left ventricular lead placement to guide cardiac resynchronization therapy: the TARGET study: a randomized, controlled trial.
      • Nguyen U.C.
      • Mafi-Rad M.
      • Aben J.P.
      • et al.
      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.
      • 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.
      • 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.
      • Rad M.M.
      • Blaauw Y.
      • Dinh T.
      • et al.
      Left ventricular lead placement in the latest activated region guided by coronary venous electroanatomic mapping.
      • Laksman Z.
      • Yee R.
      • Stirrat J.
      • et al.
      Model-based navigation of left and right ventricular leads to optimal targets for cardiac resynchronization therapy: a single-center feasibility study.
      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.
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      References

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