Sommer Anders, Kronborg Mads Brix, Nørgaard Bjarne Linde, Gerdes Christian, Mortensen Peter Thomas, Nielsen Jens Cosedis
Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus N DK-8200, Denmark
Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus N DK-8200, Denmark.
Europace. 2014 Sep;16(9):1334-41. doi: 10.1093/europace/euu056. Epub 2014 Mar 30.
Fluoroscopy is the routine method for localizing left ventricular (LV) and right ventricular (RV) lead positions in cardiac resynchronization therapy (CRT). However, the ability of fluoroscopy to determine lead positions in a standard ventricular segmentation is unknown. We aimed to evaluate the accuracy and reproducibility of fluoroscopy to determine LV and RV lead positions in CRT when compared with cardiac computed tomography (CT).
Fifty-nine patients undergoing CRT were included. Bi-plane fluoroscopy and cardiac CT were evaluated in all patients. Pacing lead positions were assessed in a standard LV 16-segment model and in a simplistic RV 8-segment model. Four patients with LV lead displacement were excluded from the agreement analysis of LV lead position. Agreement of LV lead position between fluoroscopy and cardiac CT was observed in 19 (35%) patients with fluoroscopy demonstrating a 1-segment and ≥2-segment error in 30 (55%) and 6 (11%) patients, respectively. Agreement of RV lead position was found in 13 (22%) patients with fluoroscopy showing a 1-segment and ≥ 2-segment error in 28 (47%) and 18 (31%) patients, respectively. The interobserver agreement on LV and RV lead positions was poor for fluoroscopy (kappa 0.20 and 0.23, respectively) and excellent for cardiac CT (kappa 0.87 and 0.85, respectively).
Fluoroscopy is inaccurate and modestly reproducible when assessing LV and RV lead positions in a standard ventricular segmentation when compared with cardiac CT. Cardiac CT should be applied to determine the exact pacing site in future research evaluating the optimal pacing lead position in CRT.
荧光透视检查是心脏再同步治疗（CRT）中确定左心室（LV）和右心室（RV）导线位置的常规方法。然而，荧光透视检查在标准心室分割中确定导线位置的能力尚不清楚。我们旨在评估与心脏计算机断层扫描（CT）相比，荧光透视检查在CRT中确定LV和RV导线位置的准确性和可重复性。
纳入59例行CRT的患者。对所有患者进行双平面荧光透视检查和心脏CT检查。在标准的LV 16节段模型和简化的RV 8节段模型中评估起搏导线位置。4例LV导线移位患者被排除在LV导线位置的一致性分析之外。荧光透视检查与心脏CT之间LV导线位置的一致性在19例（35%）患者中观察到，荧光透视检查分别在30例（55%）和6例（11%）患者中显示1节段和≥2节段误差。在13例（22%）患者中发现RV导线位置一致，荧光透视检查分别在28例（47%）和18例（31%）患者中显示1节段和≥2节段误差。荧光透视检查对LV和RV导线位置的观察者间一致性较差（kappa分别为0.20和0.23），而心脏CT的观察者间一致性良好（kappa分别为0.87和0.85）。
与心脏CT相比，荧光透视检查在标准心室分割中评估LV和RV导线位置时不准确且可重复性一般。在未来评估CRT中最佳起搏导线位置的研究中，应应用心脏CT来确定确切的起搏部位。
