Ludwig Daniel R, Menon Prahlad G, Schwartzman David
Division of Radiology, University of Pittsburgh, Pittsburgh, PA, USA.
QuantMD, LLC, Pittsburgh, PA, USA.
J Interv Card Electrophysiol. 2015 Dec;44(3):273-7. doi: 10.1007/s10840-015-0046-9. Epub 2015 Aug 30.
Current techniques for left ventricular (LV) lead implantation in patients with ischemic cardiomyopathy (ICM) typically underutilize information which is important for optimal lead location, including LV mechanical activation pattern and scar location. We sought to develop a technique in which this information, contained in single-photon emission computed tomographic (SPECT) images, could be integrated as to guide the electrophysiologist during the implantation procedure.
Five ICM patients underwent SPECT as well as multidetector cardiac computed tomographic (MDCT) imaging prior to the LV lead implantation procedure. Images were merged to create a "fusion" image, in which the SPECT data were projected onto the anatomically accurate MDCT epicardial surface. The fusion image was registered to the operative field using the coronary veins, apparent on the MDCT image, as a fiducial system. After registration, LV lead implantation was guided by the fusion image using a commercial catheter navigation system.
Successful guidance was achieved in each patient, with minimal disturbance to standard workflow. Leads were implanted in late-activating, unscarred regions according to the fusion image, with locations corroborated by fluoroscopic and electrographic features. In regions where leads were contiguous to the phrenic nerve shown on the fusion image, pacing consistently demonstrated diaphragmatic stimulation.
In this technical report, the description and feasibility of a new technique for SPECT image-guided LV pacing lead navigation is demonstrated. Prospective study will be required to confirm image precision and registration/navigation accuracy, as well as to demonstrate value relative to standard implantation techniques.
目前用于缺血性心肌病（ICM）患者左心室（LV）导线植入的技术通常未充分利用对最佳导线位置很重要的信息，包括左心室机械激活模式和瘢痕位置。我们试图开发一种技术，将单光子发射计算机断层扫描（SPECT）图像中包含的这些信息整合起来，以在植入过程中指导电生理学家。
五名ICM患者在进行LV导线植入手术前接受了SPECT以及多排心脏计算机断层扫描（MDCT）成像。图像进行合并以创建一个“融合”图像，其中SPECT数据被投影到解剖学上准确的MDCT心外膜表面。利用MDCT图像上可见的冠状静脉作为基准系统，将融合图像与手术视野进行配准。配准后，使用商业导管导航系统通过融合图像指导LV导线植入。
每位患者均成功获得指导，对标准工作流程的干扰最小。根据融合图像，导线被植入到激活较晚、无瘢痕的区域，其位置通过荧光镜和电图特征得到证实。在融合图像上显示导线与膈神经相邻的区域，起搏始终表现出膈肌刺激。
在本技术报告中，展示了一种用于SPECT图像引导LV起搏导线导航的新技术的描述及其可行性。需要进行前瞻性研究以确认图像精度和配准/导航准确性，以及证明相对于标准植入技术的价值。
