School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom; Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.
School of Biomedical Engineering and Imaging Sciences, King's College London, London, United Kingdom.
Heart Rhythm. 2023 Nov;20(11):1481-1488. doi: 10.1016/j.hrthm.2023.07.007. Epub 2023 Jul 13.
The WiSE-CRT System (EBR systems, Sunnyvale, CA) permits leadless left ventricular pacing. Currently, no intraprocedural guidance is used to target optimal electrode placement while simultaneously guiding acoustic transmitter placement in close proximity to the electrode to ensure adequate power delivery.
The purpose of this study was to assess the use of computed tomography (CT) anatomy, dynamic perfusion and mechanics, and predicted activation pattern to identify both the optimal electrode and transmitter locations.
A novel CT protocol was developed using preprocedural imaging and simulation to identify target segments (TSs) for electrode implantation, with late electrical and mechanical activation, with ≥5 mm wall thickness without perfusion defects. Modeling of the acoustic intensity from different transmitter implantation sites to the TSs was used to identify the optimal transmitter location. During implantation, TSs were overlaid on fluoroscopy to guide optimal electrode location that were evaluated by acute hemodynamic response (AHR) by measuring the maximal rate of left ventricular pressure rise with biventricular pacing.
Ten patients underwent the implantation procedure. The transmitter could be implanted within the recommended site on the basis of preprocedural analysis in all patients. CT identified a mean of 4.8 ± 3.5 segments per patient with wall thickness < 5 mm. During electrode implantation, biventricular pacing within TSs resulted in a significant improvement in AHR vs non-TSs (25.5% ± 8.8% vs 12.9% ± 8.6%; P < .001). Pacing in CT-identified scar resulted in either failure to capture or minimal AHR improvement. The electrode was targeted to the TSs in all patients and was implanted in the TSs in 80%.
Preprocedural imaging and modeling data with intraprocedural guidance can successfully guide WiSE-CRT electrode and transmitter implantation to allow optimal AHR and adequate power delivery.
WiSE-CRT 系统（EBR 系统，加利福尼亚州森尼韦尔）允许无导线左心室起搏。目前，在同时引导声学发射器靠近电极以确保足够功率传输的情况下，没有术中指导来定位最佳电极位置。
本研究的目的是评估使用计算机断层扫描 (CT) 解剖、动态灌注和力学以及预测激活模式来识别最佳电极和发射器位置。
使用术前成像和模拟开发了一种新的 CT 方案，以识别具有≥5mm 壁厚且无灌注缺陷的目标段 (TS) 以进行电极植入，具有晚期电和机械激活。使用来自不同发射器植入部位到 TS 的声强模型来识别最佳发射器位置。在植入过程中，将 TS 叠加在透视荧光屏上，以引导最佳电极位置，通过测量双心室起搏时左心室压力上升的最大速率来评估急性血液动力学反应 (AHR)。
十名患者接受了植入手术。根据术前分析，所有患者都可以在推荐的部位植入发射器。CT 确定了每个患者平均 4.8 ± 3.5 个壁厚<5mm 的节段。在电极植入期间，TS 内的双心室起搏导致 AHR 与非 TS 相比显著改善（25.5%±8.8%比 12.9%±8.6%；P<.001）。CT 识别的瘢痕内起搏导致无法捕获或 AHR 改善最小。所有患者的电极均靶向 TS，并将电极植入 TS 中 80%。
术前成像和建模数据与术中指导相结合，可以成功指导 WiSE-CRT 电极和发射器植入，以实现最佳 AHR 和足够的功率传输。
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