Left ventricular lead placement in the latest activated region guided by coronary venous electroanatomic mapping

Rad, Masih Mafi; Blaauw, Yuri; Dinh, Trang; Pison, Laurent; Crijns, Harry J.G.M.; Prinzen, Frits W.; Vernooy, Kevin

doi:10.1093/europace/euu221

Cited by 53 publications

(19 citation statements)

References 40 publications

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“…Coronary venous electroanatomical mapping allows the assessment of electrical latency exclusively within the CS [23]. A high degree of variability in the location of the site of LEA was observed between patients.…”

Section: Identifying the Site Of Latest Electrical Activation (Lea)mentioning

confidence: 99%

“…Suboptimal LV lead position is a common culprit when evaluating poor outcomes after CRT [4–7]. Equally, several groups have reported enhanced response rates when targeting tissue which displays evidence of favorable viability [8–11] or advantageous mechanical [12–18] or electrical [19–23] properties. This review will evaluate how to define the optimal LV pacing site and the mechanisms by which it is possible to selectively deploy a pacing electrode at this site.…”

Section: Introductionmentioning

confidence: 99%

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Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

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Introduction: Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment.Areas covered: This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT.Expert commentary: Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.

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Section: Identifying the Site Of Latest Electrical Activation (Lea)mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

View full text Add to dashboard Cite

show abstract

“…RV lead positions were classified as apical or septal. LV lead positions were classified as basal, mid, or apical in the right anterior oblique view and as anterior, anterolateral, lateral, posterolateral, or posterior in the left anterior oblique view 17. After implantation, atrioventricular and ventriculo-ventricular delays were determined showing the greatest stroke volume (Doppler-guided) or narrowest QRS duration (ECG-based) before discharge.…”

Section: Methodsmentioning

confidence: 99%

Comparison of De Novo versus Upgrade Cardiac Resynchronization Therapy; Focused on the Upgrade for Pacing-Induced Cardiomyopathy

et al. 2017

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PurposeThis study aimed to determine whether upgrade cardiac resynchronization therapy (CRT) shows better outcomes than de novo CRT. To do so, we compared the efficacy of CRT between de novo and upgrade groups, focusing particularly on the effect of upgrade CRT on patients with pacing-induced cardiomyopathy (PiCM).Materials and MethodsPiCM was defined as new-onset dilated cardiomyopathy following pacemaker implantation in patients with baseline normal ejection fraction ≥50%. Electro-mechanical reverse remodeling and clinical outcomes were compared among the de novo (n=62), PiCM upgrade (n=7), and non-PiCM upgrade (n=8) CRT groups.ResultsThe PiCM upgrade group showed significantly greater electro-mechanical reverse remodeling than the de novo CRT or non-PiCM upgrade groups at 6-month follow-up. The rate of super-responders was significantly higher in the PiCM upgrade group than the other CRT groups. The group factor of the PiCM upgrade was identified as an independent predictor of super-responder in multivariate analysis (odds ratio 10.4, 95% confidential interval 1.08–99.4, p=0.043). During the median follow-up of 15.8 months, the PiCM upgrade group showed the lowest rate of composite clinical outcomes, including cardiac death, heart transplantation, and heart failure-related rehospitalization (p=0.059).ConclusionThe upgrade CRT for PiCM patients showed better performance in terms of electro-mechanical reverse remodeling than de novo implantation or upgrade CRT in non-PiCM patients.

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“…Coronary venous 3D electroanatomical mapping was performed at the time of CRT implantation as described previously [ 10 ]. In brief, prior to LV lead placement, a 0.014 inch guidewire (Vision Wire, Biotronik SE & Co.KG), which permits unipolar sensing and pacing, was inserted into the coronary sinus and connected to an EnSite NavX system (St Jude Medical, St Paul, MN, USA).…”

Section: Methodsmentioning

confidence: 99%

“…However, recent studies have suggested that CRT may be beneficial in a subset of IVCD patients with evidence of LV activation delay [ 6 – 9 ]. Recently, we introduced coronary venous electroanatomical mapping as a tool to assess LV electrical activation at the time of CRT implantation in patients with LBBB [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Identifying delayed left ventricular lateral wall activation in patients with non-specific intraventricular conduction delay using coronary venous electroanatomical mapping

et al. 2015

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BackgroundDelayed left ventricular (LV) lateral wall activation is considered the electrical substrate that characterises patients suitable for cardiac resynchronisation therapy (CRT). Although typically associated with left bundle branch block, delayed LV lateral wall activation may also be present in patients with non-specific intraventricular conduction delay (IVCD). We assessed LV lateral wall activation in a cohort of CRT candidates with IVCD using coronary venous electroanatomical mapping, and investigated whether baseline QRS characteristics on the ECG can identify delayed LV lateral wall activation in this group of patients.MethodsTwenty-three consecutive CRT candidates with IVCD underwent intra-procedural coronary venous electroanatomical mapping using EnSite NavX. Electrical activation time was measured in milliseconds from QRS onset and expressed as percentage of QRS duration. LV lateral wall activation was considered delayed if maximal activation time measured at the LV lateral wall (LVLW-AT) exceeded 75 % of the QRS duration. QRS morphology, duration, fragmentation, axis deviation, and left anterior/posterior fascicular block were assessed on baseline ECGs.ResultsDelayed LV lateral wall activation occurred in 12/23 patients (maximal LVLW-AT = 133 ± 20 ms [83 ± 5 % of QRS duration]). In these patients, the latest activated region was consistently located on the basal lateral wall. QRS duration, and prevalence of QRS fragmentation and left/right axis deviation, and left anterior/posterior fascicular block did not differ between patients with and without delayed LV lateral wall activation.ConclusionCoronary venous electroanatomical mapping can be used at the time of CRT implantation to determine the presence of delayed LV lateral wall activation in patients with IVCD. QRS characteristics on the ECG seem unable to identify delayed LV lateral wall activation in this subgroup of patients.

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Left ventricular lead placement in the latest activated region guided by coronary venous electroanatomic mapping

Cited by 53 publications

References 40 publications

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Comparison of De Novo versus Upgrade Cardiac Resynchronization Therapy; Focused on the Upgrade for Pacing-Induced Cardiomyopathy

Identifying delayed left ventricular lateral wall activation in patients with non-specific intraventricular conduction delay using coronary venous electroanatomical mapping

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