Wouters Philippe C, van Slochteren Frebus J, Tuinenburg Anton E, Doevendans Pieter A, Cramer Maarten-Jan M, Delnoy Peter-Paul H M, van Dijk Vincent F, Meine Mathias
Department of Cardiology, UMC Utrecht, Utrecht, the Netherlands.
CART-Tech BV, Utrecht, the Netherlands.
Heart Rhythm O2. 2022 Oct 18;4(1):9-17. doi: 10.1016/j.hroo.2022.10.002. eCollection 2023 Jan.
Image guidance to assist left ventricular (LV) lead placement may improve outcome after cardiac resynchronization therapy (CRT), but previous approaches and results varied greatly, and multicenter feasibility is lacking altogether.
We sought to investigate the multicenter feasibility of image guidance for periprocedural assistance of LV lead placement for CRT.
In 30 patients from 3 hospitals, cardiac magnetic resonance imaging was performed within 3 months prior to CRT 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 for LV lead placement, according to an accurate 36-segment model of the whole heart. LV leads were navigated using image overlay with periprocedural fluoroscopy. After 6 months, volumetric response and super-response were defined as ≥15% or ≥30% reduction in LV end-systolic volume, respectively.
Periprocedural image guidance was successfully performed in all CRT patients (age 66 ± 10 years; 59% men, 62% with nonischemic cardiomyopathy, 69% with left bundle branch block). LV leads were placed as follows: within (14%), adjacent (62%), or remote (24%) from the predefined target. According to the conventional 18-segment model, a remote position occurred only once (3%). On average, 86% of patients demonstrated a volumetric response (mean LV end-systolic volume reduction 36 ± 29%), and 66% of all patients were super-responders.
On-screen image guidance for LV lead placement in CRT was feasible in a multicenter setting. Efficacy will be further investigated in the randomized controlled ADVISE (Advanced Image Supported Lead Placement in Cardiac Resynchronization Therapy) trial (NCT05053568).
图像引导辅助左心室（LV）导线植入可能会改善心脏再同步治疗（CRT）后的疗效，但先前的方法和结果差异很大，且完全缺乏多中心可行性研究。
我们旨在研究图像引导在CRT术中辅助LV导线植入的多中心可行性。
在来自3家医院的30例患者中，于CRT术前3个月内进行心脏磁共振成像，以识别心肌瘢痕和晚期机械激活（LMA）。使用径向应变测定LMA，并随时间绘制。根据精确的全心脏36节段模型，无瘢痕但有明显LMA的节段被归类为LV导线植入的最佳位置。术中使用图像叠加和透视引导LV导线植入。6个月后，将容积反应和超反应分别定义为左心室收缩末期容积减少≥15%或≥30%。
所有CRT患者（年龄66±10岁；59%为男性，62%患有非缺血性心肌病，69%患有左束支传导阻滞）均成功进行了术中图像引导。LV导线植入位置如下：在预定义目标内（14%）、相邻（62%）或远离（24%）。根据传统的18节段模型，远离位置仅出现一次（3%）。平均而言，86%的患者表现出容积反应（左心室收缩末期容积平均减少36±29%），所有患者中有66%为超反应者。
CRT术中LV导线植入的屏幕图像引导在多中心环境中是可行的。疗效将在随机对照的ADVISE（心脏再同步治疗中先进图像支持的导线植入）试验（NCT05053568）中进一步研究。
