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Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy

Research output: Contribution to journalArticle

Jonathan M. Behar, Ronak Rajani, Amir Pourmorteza, Rebecca Preston, Orod Razeghi, Steve Niederer, Shaumik Adhya, Simon Claridge, Tom Jackson, Ben Sieniewicz, Justin Gould, Gerry Carr-White, Reza Razavi, Elliot McVeigh, Christopher Aldo Rinaldi

Original languageEnglish
Pages (from-to)1364-1372
Number of pages9
JournalHeart Rhythm
Volume14
Issue number9
DOIs
Publication statusE-pub ahead of print - 4 May 2017

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Abstract

BACKGROUND: Optimal lead positioning is an important determinant of cardiac resynchronization therapy (CRT) response.

OBJECTIVE: The purpose of this study was to evaluate cardiac computed tomography (CT) selection of the optimal epicardial vein for left ventricular (LV) lead placement by targeting regions of late mechanical activation and avoiding myocardial scar.

METHODS: Eighteen patients undergoing CRT upgrade with existing pacing systems underwent preimplant electrocardiogram-gated cardiac CT to assess wall thickness, hypoperfusion, late mechanical activation, and regions of myocardial scar by the derivation of the stretch quantifier for endocardial engraved zones (SQUEEZ) algorithm. Cardiac venous anatomy was mapped to individualized AHA bull's-eye plots to identify the optimal venous target and compared with acute hemodynamic response (AHR) in each coronary venous target using an LV pressure wire.

RESULTS: Fifteen data sets were evaluable. CT-SQUEEZ-derived targets produced a similar mean AHR compared with the best achievable AHR (20.4% ± 13.7% vs 24.9% ± 11.1%; P = .36). SQUEEZ-derived guidance produced a positive AHR in 92% of target segments, and pacing in a CT-SQUEEZ target vein produced a greater clinical response rate vs nontarget segments (90% vs 60%).

CONCLUSION: Preprocedural CT-SQUEEZ-derived target selection may be a valuable tool to predict the optimal venous site for LV lead placement in patients undergoing CRT upgrade.

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