Usefulness of multidetector computed tomography coronary venous angiography examination before cardiac resynchronization therapy

Abstract

Cardiac resynchronization therapy (CRT) is a treatment option for selected heart failure patients. In this study, the aim was to evaluate the usefulness of noninvasive cardiac vein imaging using multidetector computed tomography (MDCT) angiography before CRT. The MDCT scans of 34 patients (20 men; age range 47-65 years) with a history of cardiac failure were studied for CRT in two centers prospectively. The anatomy of the cardiac venous system, particularly the target veins [left marginal vein (LMV) and posterior vein of the left ventricle (PVLV)], was evaluated with noninvasive MDCT. The coronary sinus, anterior interventricular vein, and posterior interventricular vein were observed in all patients. The PVLV was present in 30 (88.2%) patients. The PVLV was chosen in 30 (88.2%) patients for CRT. If the PVLV had two or more branches, the widest branch was chosen for lead implantation. In four (11.7%) patients, the PVLV was absent and the LMV was chosen instead for lead implantation. In one patient (2.9%), partial thrombosis was detected in the coronary sinus with MDCT angiography. MDCT can be used to guide interventionalists for CRT by providing anatomical details of the cardiac venous system rapidly and noninvasively.