Duckett Simon G, Ginks Matthew R, Knowles Benjamin R, Ma Yingliang, Shetty Anoop, Bostock Julian, Cooklin Michael, Gill Jas S, Carr-White Gerry S, Razavi Reza, Schaeffter Tobias, Rhode Kawal S, Rinaldi C Aldo
Division of Imaging Sciences, King's College London, BHF Centre, NIHR Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust, London, UK.
Pacing Clin Electrophysiol. 2011 Feb;34(2):226-34. doi: 10.1111/j.1540-8159.2010.02940.x. Epub 2010 Oct 28.
Failure rate for left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) is up to 12%. The use of segmentation tools, advanced image registration software, and high-fidelity images from computerized tomography (CT) and cardiac magnetic resonance (CMR) of the coronary sinus (CS) can guide LV lead implantation. We evaluated the feasibility of advanced image registration onto live fluoroscopic images to allow successful LV lead placement.
Twelve patients (11 male, 59 ± 16.8 years) undergoing CRT had three-dimensional (3D) whole-heart imaging (six CT, six CMR). Eight patients had at least one previously failed LV lead implant. Using segmentation software, anatomical models of the cardiac chambers, CS, and its branches were overlaid onto the live fluoroscopy using a prototype version of the Philips EP Navigator software to guide lead implantation.
We achieved high-fidelity segmentations of cardiac chambers, coronary vein anatomy, and accurate registration between the 3D anatomical models and the live fluoroscopy in all 12 patients confirmed by balloon occlusion angiography. The CS was cannulated successfully in every patient and in 11, an LV lead was implanted successfully. (One patient had no acceptable lead values due to extensive myocardial scar).
Using overlaid 3D segmentations of the CS and cardiac chambers, it is feasible to guide CRT implantation in real time by fusing advanced imaging and fluoroscopy. This enabled successful CRT in a group of patients with previously failed implants. This technology has the potential to facilitate CRT and improve implant success.
心脏再同步治疗（CRT）中左心室（LV）导联植入的失败率高达12%。使用分割工具、先进的图像配准软件以及来自冠状动脉窦（CS）的计算机断层扫描（CT）和心脏磁共振（CMR）的高保真图像可以指导LV导联植入。我们评估了将先进图像配准到实时荧光透视图像上以成功放置LV导联的可行性。
12例接受CRT的患者（11例男性，年龄59±16.8岁）进行了三维（3D）全心成像（6例CT，6例CMR）。8例患者至少有一次LV导联植入失败。使用分割软件，通过飞利浦EP Navigator软件的原型版本将心腔、CS及其分支的解剖模型叠加到实时荧光透视上以指导导联植入。
通过球囊闭塞血管造影证实，在所有12例患者中，我们实现了心腔、冠状静脉解剖结构的高保真分割以及3D解剖模型与实时荧光透视之间的精确配准。每位患者的CS均成功插管，11例成功植入LV导联。（1例患者因广泛心肌瘢痕而无合适的导联值）。
使用CS和心腔的叠加3D分割，通过融合先进成像和荧光透视实时指导CRT植入是可行的。这使得一组先前植入失败的患者成功接受了CRT。这项技术有可能促进CRT并提高植入成功率。
