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Optimal site selection & image fusion guidance technology to facilitate cardiac resynchronisation therapy

Research output: Contribution to journalReview article

Original languageEnglish
JournalExpert Review Of Medical Devices
Publication statusAccepted/In press - 12 Jul 2018

King's Authors


Introduction: Cardiac resynchronisation therapy (CRT) has emerged as one of the few effective treatments for heart failure however, up to 50% of patients derive no benefit. Suboptimal LV lead position is a potential cause of poor outcomes whilst targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment.
Areas Covered: This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favourable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT.
Expert Commentary: Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterisation and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of CS anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.

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