Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy

Jonathan M. Behar; Ronak Rajani; Amir Pourmorteza; Rebecca Preston; Orod Razeghi; Steve Niederer; Shaumik Adhya; Simon Claridge; Tom Jackson; Ben Sieniewicz; Justin Gould; Gerry Carr-White; Reza Razavi; Elliot McVeigh; Christopher Aldo Rinaldi

doi:10.1016/j.hrthm.2017.04.041

Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy

Jonathan M. Behar, Ronak Rajani, Amir Pourmorteza, Rebecca Preston, Orod Razeghi, Steve Niederer, Shaumik Adhya, Simon Claridge, Tom Jackson, Ben Sieniewicz, Justin Gould, Gerry Carr-White, Reza Razavi, Elliot McVeigh, Christopher Aldo Rinaldi

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Abstract

BACKGROUND: Optimal lead positioning is an important determinant of cardiac resynchronization therapy (CRT) response.

OBJECTIVE: The purpose of this study was to evaluate cardiac computed tomography (CT) selection of the optimal epicardial vein for left ventricular (LV) lead placement by targeting regions of late mechanical activation and avoiding myocardial scar.

METHODS: Eighteen patients undergoing CRT upgrade with existing pacing systems underwent preimplant electrocardiogram-gated cardiac CT to assess wall thickness, hypoperfusion, late mechanical activation, and regions of myocardial scar by the derivation of the stretch quantifier for endocardial engraved zones (SQUEEZ) algorithm. Cardiac venous anatomy was mapped to individualized AHA bull's-eye plots to identify the optimal venous target and compared with acute hemodynamic response (AHR) in each coronary venous target using an LV pressure wire.

RESULTS: Fifteen data sets were evaluable. CT-SQUEEZ-derived targets produced a similar mean AHR compared with the best achievable AHR (20.4% ± 13.7% vs 24.9% ± 11.1%; P = .36). SQUEEZ-derived guidance produced a positive AHR in 92% of target segments, and pacing in a CT-SQUEEZ target vein produced a greater clinical response rate vs nontarget segments (90% vs 60%).

CONCLUSION: Preprocedural CT-SQUEEZ-derived target selection may be a valuable tool to predict the optimal venous site for LV lead placement in patients undergoing CRT upgrade.

Original language	English
Pages (from-to)	1364-1372
Number of pages	9
Journal	Heart Rhythm
Volume	14
Issue number	9
DOIs	https://doi.org/10.1016/j.hrthm.2017.04.041
Publication status	E-pub ahead of print - 4 May 2017

Keywords

Cardiac computed tomography
Cardiac Resynchronization Therapy
Image Guided Interventions
DYSSYNCHRONY
Myocardial fibrosis

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Behar, J. M., Rajani, R., Pourmorteza, A., Preston, R., Razeghi, O., Niederer, S., Adhya, S., Claridge, S., Jackson, T., Sieniewicz, B., Gould, J., Carr-White, G., Razavi, R., McVeigh, E., & Rinaldi, C. A. (2017). Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy. Heart Rhythm, 14(9), 1364-1372. Advance online publication. https://doi.org/10.1016/j.hrthm.2017.04.041

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title = "Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy",

abstract = "BACKGROUND: Optimal lead positioning is an important determinant of cardiac resynchronization therapy (CRT) response.OBJECTIVE: The purpose of this study was to evaluate cardiac computed tomography (CT) selection of the optimal epicardial vein for left ventricular (LV) lead placement by targeting regions of late mechanical activation and avoiding myocardial scar.METHODS: Eighteen patients undergoing CRT upgrade with existing pacing systems underwent preimplant electrocardiogram-gated cardiac CT to assess wall thickness, hypoperfusion, late mechanical activation, and regions of myocardial scar by the derivation of the stretch quantifier for endocardial engraved zones (SQUEEZ) algorithm. Cardiac venous anatomy was mapped to individualized AHA bull's-eye plots to identify the optimal venous target and compared with acute hemodynamic response (AHR) in each coronary venous target using an LV pressure wire.RESULTS: Fifteen data sets were evaluable. CT-SQUEEZ-derived targets produced a similar mean AHR compared with the best achievable AHR (20.4% ± 13.7% vs 24.9% ± 11.1%; P = .36). SQUEEZ-derived guidance produced a positive AHR in 92% of target segments, and pacing in a CT-SQUEEZ target vein produced a greater clinical response rate vs nontarget segments (90% vs 60%).CONCLUSION: Preprocedural CT-SQUEEZ-derived target selection may be a valuable tool to predict the optimal venous site for LV lead placement in patients undergoing CRT upgrade.",

keywords = "Cardiac computed tomography, Cardiac Resynchronization Therapy, Image Guided Interventions, DYSSYNCHRONY, Myocardial fibrosis",

author = "Behar, {Jonathan M.} and Ronak Rajani and Amir Pourmorteza and Rebecca Preston and Orod Razeghi and Steve Niederer and Shaumik Adhya and Simon Claridge and Tom Jackson and Ben Sieniewicz and Justin Gould and Gerry Carr-White and Reza Razavi and Elliot McVeigh and Rinaldi, {Christopher Aldo}",

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doi = "10.1016/j.hrthm.2017.04.041",

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Behar, JM , Rajani, R, Pourmorteza, A, Preston, R, Razeghi, O , Niederer, S, Adhya, S, Claridge, S , Jackson, T , Sieniewicz, B , Gould, J, Carr-White, G, Razavi, R, McVeigh, E & Rinaldi, CA 2017, 'Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy', Heart Rhythm, vol. 14, no. 9, pp. 1364-1372. https://doi.org/10.1016/j.hrthm.2017.04.041

TY - JOUR

T1 - Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy

AU - Behar, Jonathan M.

AU - Rajani, Ronak

AU - Pourmorteza, Amir

AU - Preston, Rebecca

AU - Razeghi, Orod

AU - Niederer, Steve

AU - Adhya, Shaumik

AU - Claridge, Simon

AU - Jackson, Tom

AU - Sieniewicz, Ben

AU - Gould, Justin

AU - Carr-White, Gerry

AU - Razavi, Reza

AU - McVeigh, Elliot

AU - Rinaldi, Christopher Aldo

PY - 2017/5/4

Y1 - 2017/5/4

N2 - BACKGROUND: Optimal lead positioning is an important determinant of cardiac resynchronization therapy (CRT) response.OBJECTIVE: The purpose of this study was to evaluate cardiac computed tomography (CT) selection of the optimal epicardial vein for left ventricular (LV) lead placement by targeting regions of late mechanical activation and avoiding myocardial scar.METHODS: Eighteen patients undergoing CRT upgrade with existing pacing systems underwent preimplant electrocardiogram-gated cardiac CT to assess wall thickness, hypoperfusion, late mechanical activation, and regions of myocardial scar by the derivation of the stretch quantifier for endocardial engraved zones (SQUEEZ) algorithm. Cardiac venous anatomy was mapped to individualized AHA bull's-eye plots to identify the optimal venous target and compared with acute hemodynamic response (AHR) in each coronary venous target using an LV pressure wire.RESULTS: Fifteen data sets were evaluable. CT-SQUEEZ-derived targets produced a similar mean AHR compared with the best achievable AHR (20.4% ± 13.7% vs 24.9% ± 11.1%; P = .36). SQUEEZ-derived guidance produced a positive AHR in 92% of target segments, and pacing in a CT-SQUEEZ target vein produced a greater clinical response rate vs nontarget segments (90% vs 60%).CONCLUSION: Preprocedural CT-SQUEEZ-derived target selection may be a valuable tool to predict the optimal venous site for LV lead placement in patients undergoing CRT upgrade.

AB - BACKGROUND: Optimal lead positioning is an important determinant of cardiac resynchronization therapy (CRT) response.OBJECTIVE: The purpose of this study was to evaluate cardiac computed tomography (CT) selection of the optimal epicardial vein for left ventricular (LV) lead placement by targeting regions of late mechanical activation and avoiding myocardial scar.METHODS: Eighteen patients undergoing CRT upgrade with existing pacing systems underwent preimplant electrocardiogram-gated cardiac CT to assess wall thickness, hypoperfusion, late mechanical activation, and regions of myocardial scar by the derivation of the stretch quantifier for endocardial engraved zones (SQUEEZ) algorithm. Cardiac venous anatomy was mapped to individualized AHA bull's-eye plots to identify the optimal venous target and compared with acute hemodynamic response (AHR) in each coronary venous target using an LV pressure wire.RESULTS: Fifteen data sets were evaluable. CT-SQUEEZ-derived targets produced a similar mean AHR compared with the best achievable AHR (20.4% ± 13.7% vs 24.9% ± 11.1%; P = .36). SQUEEZ-derived guidance produced a positive AHR in 92% of target segments, and pacing in a CT-SQUEEZ target vein produced a greater clinical response rate vs nontarget segments (90% vs 60%).CONCLUSION: Preprocedural CT-SQUEEZ-derived target selection may be a valuable tool to predict the optimal venous site for LV lead placement in patients undergoing CRT upgrade.

KW - Cardiac computed tomography

KW - Cardiac Resynchronization Therapy

KW - Image Guided Interventions

KW - DYSSYNCHRONY

KW - Myocardial fibrosis

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DO - 10.1016/j.hrthm.2017.04.041

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SN - 1547-5271

VL - 14

SP - 1364

EP - 1372

JO - Heart Rhythm

JF - Heart Rhythm

IS - 9

ER -

Comprehensive use of cardiac computed tomography to guide left ventricular lead placement in cardiac resynchronization therapy

Abstract

Keywords

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