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A Planning and Guidance Platform for Cardiac Resynchronization Therapy

Research output: Contribution to journalArticle

Peter Mountney, Jonathan M Behar, Daniel Toth, Maria Panayiotou, Sabrina Reiml, Marie-Pierre Jolly, Rashed Karim, Li Zhang, Alexander Brost, Christopher A Rinaldi, Kawal Rhode

Original languageEnglish
Pages (from-to)2366 - 2375
JournalIEEE Transactions on Medical Imaging
Issue number11
Early online date27 Jun 2017
Publication statusPublished - Nov 2017


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    Accepted author manuscript

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King's Authors


Patients with drug-refractory heart failure can greatly benefit from cardiac resynchronization therapy (CRT). A CRT device can resynchronize the contractions of the left ventricle (LV) leading to reduced mortality. Unfortunately 30- 50% of patients do not respond to treatment when assessed by objective criteria such as cardiac remodeling. A significant contributing factor is suboptimal placement of the LV lead. It has been shown that placing this lead away from scar and at the point of latest mechanical activation can improve response rates. This paper presents a comprehensive and highly automated system that uses scar and mechanical activation to plan and guide CRT procedures. Standard clinical preoperative magnetic resonance imaging is used to extract scar and mechanical activation information. The data is registered to a single 3D coordinate system and visualized in novel 3D and 2D American Heart Association plots enabling the clinician to select target segments. During the procedure, the planning information is overlaid onto live fluoroscopic images to guide lead deployment. The proposed platform has been used during 14 CRT procedures and validated on synthetic, phantom, volunteer and patient data.

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