A novel approach for left ventricular lead placement in cardiac resynchronization therapy: Intraprocedural integration of coronary venous electroanatomic mapping with delayed enhancement cardiac magnetic resonance imaging
A novel approach for left ventricular lead placement in cardiac resynchronization therapy: Intraprocedural integration of coronary venous electroanatomic mapping with delayed enhancement cardiac magnetic resonance imaging
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DOI：
10.1016/j.hrthm.2016.09.015
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发表时间：
2017-01-01
期刊：
影响因子：
5.5
通讯作者：
Vernooy, Kevin
中科院分区：
文献类型：
--
作者：
Uyen Chau Nguyen;Mafi-Rad, Masih;Vernooy, Kevin
背景：将左心室（LV）导联放置在远离疤痕的晚期电激活部位可以改善心脏再同步化治疗（CRT）的反应。目的：本研究的目的是将冠状静脉电解剖定位（EAM）与延迟增强心脏磁共振（DE-CMR）相结合，使左室导联引导到远离疤痕的最新激活静脉。方法：前瞻性纳入18例在DE-CMR上有局灶性瘢痕的CRT候选患者。DE-CMR图像进行半自动分析。术中进行冠状静脉EAM，并结合DE-CMR实时指导左室导联放置。离线评估图像集成精度和电图参数。结果：采用8.9 +/- 2.8个解剖标记实现了EAM和DE-CMR的整合，准确度为4.7 +/- 1.1 mm（平均+/- SD）。最大电延迟在72 ~ 197ms之间（占QRS持续时间的57% ~ 113%），个体间存在差异。12例患者最新激活静脉位于瘢痕外，10例患者完成了将左室导联放置在远离瘢痕的最新激活静脉，2例患者禁止放置左室导联。另外6例患者，最新激活静脉位于瘢痕，考虑替代静脉。疤痕组的单极电压平均低于非疤痕组（6.71 +/- 3.45 mV vs 8.18 +/- 4.02 mV[中位数+/-四分位数范围]）
BACKGROUND: Placing the left ventricular (LV) lead at a site of late electrical activation remote from scar is desired to improve cardiac resynchronization therapy (CRT) response. OBJECTIVE: The purpose of this study was to integrate coronary venous electroanatomic mapping (EAM) with delayed enhancement cardiac magnetic resonance (DE-CMR) enabling LV lead guidance to the latest activated vein remote from scar.METHODS: Eighteen CRT candidates with focal scar on DE-CMR were prospectively included. DE-CMR images were semi-automatically analyzed. Coronary venous EAM was performed intraprocedurally and integrated with DE-CMR to guide LV lead placement in real time. Image integration accuracy and electrogram parameters were evaluated offline.RESULTS: Integration of EAM and DE-CMR was achieved using 8.9 +/- 2.8 anatomic landmarks and with accuracy of 4.7 +/- 1.1 mm (mean +/- SD). Maximal electrical delay ranged between 72 and 197ms (57%-113% of QRS duration) and was heterogeneously located among individuals. In 12 patients, the latest activated vein was located outside scar, and placing the LV lead in the latest activated vein remote from scar was accomplished in 10 patients and prohibited in 2 patients. In the other 6 patients, the latest activated vein was located in scar, and targeting alternative veins was considered. Unipolar voltages were on average lower in scar compared to nonscar (6.71 +/- 3.45 mV vs 8.18 +/- 4.02 mV [median +/- interquartile range), P