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Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Research output: Contribution to journalReview articlepeer-review

Original languageEnglish
Pages (from-to)555-570
Number of pages16
JournalExpert Review Of Medical Devices
Volume15
Issue number8
Early online date30 Jul 2018
DOIs
Accepted/In press12 Jul 2018
E-pub ahead of print30 Jul 2018
Published2018

Documents

King's Authors

Abstract

Introduction: Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while 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 favorable 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 characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus 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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