Heart Failure -> Cardiac Resynchronization Therapy: -> Lead and delivery systems D-PO04 - Poster Session IV (ID 15) Poster

D-PO04-068 - Integration Of MRI And Fluoroscopy To Determine Optimal CRT Pacing Sites And Quadripolar Pacing Vectors (ID 1182)

Abstract

Background: While quadripolar left ventricular (LV) pacing leads have increased the number of possible pacing sites for cardiac resynchronization therapy (CRT) implants, substantial uncertainty remains regarding the best implant sites and optimal pacing vectors for better CRT outcomes.
Objective: The objective was to test the hypothesis that myocardial activation and scar characteristics vary significantly among different quadripolar pacing lead vectors and within most cardiac venous branches.
Methods: During CRT procedures, integration of fluoroscopic and 3D cardiac magnetic resonance (CMR) images with mechanical activation and scar was achieved using Guide CRT software (Siemens Healthcare). CMR cine DENSE (Displacement Encoding with Stimulated Echoes) strain imaging was used to create the maps.
Results: Among 10 patients (age 62.2 ± 10.4 years, 40% female) undergoing new or upgrade CRT implants with quadripolar leads, late-activated sites with DENSE were identified in 8 of the 9 patients with coronary venograms (in 13/31 coronary venous branches). In 11/13 branches, the myocardium accessible from proximal, middle, or distal aspects of the veins had substantial variability in mechanical activation (example in Figure Panel A). In 5 patients, different segments of branches of interest supplied areas with and without scar (example in Figure Panel B). The optimal cathode was distal in 5 patients, middle in 4 patients, and proximal in 1 patient.
Conclusion: Integration of fluoroscopy and CMR allows determination not only of optimal sites for lead implantation, but also the best pacing vectors. Substantial heterogeneity of tissue characteristics within venous branches was noted.
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