Integration of cardiac magnetic resonance imaging, electrocardiographic imaging, and coronary venous computed tomography angiography for guidance of left ventricular lead positioning.

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 AND RESULTS:

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.

• Authors: Uyên Châu Nguyên, Matthijs J M Cluitmans, Marc Strik, Justin G Luermans, Suzanne Gommers, Joachim E Wildberger, Sebastiaan C A M Bekkers, Paul G A Volders, Casper Mihl, Frits W Prinzen, Kevin Vernooy
• Journal: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology (Europace) Vol. 21 Issue 4 Pg. 626-635 (Apr 01 2019) ISSN: 1532-2092 [Electronic] England
• PMID: 30590434 (Publication Type: Journal Article)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2018. For permissions, please email: [email protected].

Topics

• Aged
• Aged, 80 and over
• Body Surface Potential Mapping (methods)
• Cardiac Conduction System Disease (therapy)
• Cardiac Resynchronization Therapy
• Cardiac Resynchronization Therapy Devices
• Computed Tomography Angiography (methods)
• Coronary Angiography (methods)
• Female
• Heart Ventricles
• Humans
• Image Processing, Computer-Assisted
• Magnetic Resonance Imaging, Cine (methods)
• Male
• Middle Aged
• Prospective Studies
• Prosthesis Implantation