Abstract 12414: 3D Fusion of MRI Mechanical Activation, Cardioinsight Electrical Activation, and Fluoroscopic Lead Location for CRT

Abstract

Introduction: 3D image integration can help achieve personalized medicine for patients undergoing device therapy for heart failure, such as cardiac resynchronization therapy (CRT). Hypothesis: Electrical mapping data and mechanical activation from cardiac magnetic resonance (CMR) integrated with live fluoroscopic data will provide complementary information to optimize CRT procedures. Methods: Ten patients underwent cardiac CT and electrical mapping with the CardioInsight 252-electrode vest (Medtronic) during CRT implantation using a 3D-capable fluoroscopy system (Artis zeego, Siemens) and a 3D image integration software prototype (Guide-CRT, Siemens). A myocardial mechanical activation map based on strain from CMR Displacement Encoding with Stimulated Echoes (DENSE) and an electrical activation map from CardioInsight were fused with fluoroscopic images using Guide-CRT. Results: In a representative patient with LBBB and QRS duration 140 ms, integrated 3D maps of electrical and mechanical activation with the fluoroscopic lead location are shown for right/left anterior oblique (RAO/LAO) and anterior-posterior (AP) views (Figure). While the area of late mechanical activation is centered at about 3 o’clock on the mitral annulus, a slightly more anterolateral and smaller focus of late electrical activation is noted on the CardioInsight maps (Figure). Furthermore, more basal activation data is possible with the electrical maps, as strain imaging typically starts below the mitral valve. While a middle LV electrode (LV2-4) was chosen for CRT pacing based on the CMR map, the more proximal and anterolateral LV electrode could have been chosen based on the electrical map. Conclusions: Multimodality mapping and 3D fusion of mechanical activation, electrical activation, and lead position provide important information regarding electromechanical coupling and the choice of the optimal pacing location.