Real-time image-guided lead placement in cardiac resynchronisation therapy: feasibility and outcome in a multicentre setting

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Image-guidance to assist left ventricular (LV) lead placement may improve outcome after cardiac resynchronisation therapy (CRT). Because previous approaches and results varied greatly, the optimal strategy remains unknown. To date, only a few studies investigated ‘real-time’ guidance, and feasibility in a multicentre setting is lacking altogether. Methods In 30 patients from three hospitals, cardiac magnetic resonance imaging (MRI) was performed to identify myocardial scar and late mechanical activation (LMA). LMA was determined using radial strain, plotted over time. Segments without scar but clear LMA were classified as optimal, according to an accurate 36-segment model. LV-lead deployment was guided, in real-time, using live image-overlay with fluoroscopy. After 6 months, volumetric response was defined as ≥15% reduction in LV end-systolic volume (∆LVESV). Reduction in log-transformed N-terminal pro-brain natriuretic peptide (NT-proBNP) was assessed at 2 months. Results Real-time image-guidance was successful performed in all CRT patients (age 66±10 years; 59% male, 72% non-ischemic cardiomyopathy; 69% left bundle branch block). LV-leads were deployed as follows: within (24%), adjacent (52%), or remote (24%) from the pre-defined target. According to the traditional 18-segment model, a remote position occurred only once. On average, 86% of patients demonstrated a volumetric response (mean ∆LVESV 36±29%). In addition, lead placement was association with reduction in log-transformed NT-proBNP (Figure 1). Conclusion Real-time image-guidance towards a pre-defined target for LV-lead placement was feasible in a multicentre setting, and has promising clinical results. Efficacy will be further investigated in the randomised controlled ‘Advanced Image Supported Lead Placement in Cardiac Resynchronization Therapy’ trial.