Parametric ultrasound and fluoroscopy image fusion for guidance of left ventricle lead placement in cardiac resynchronization therapy
3
Citation
33
Reference
10
Related Paper
Citation Trend
Abstract:
Recent studies show that the response rate to cardiac resynchronization therapy (CRT) could be improved if the left ventricle (LV) is paced at the site of the latest mechanical activation, but away from the myocardial scar. A prototype system for CRT lead placement guidance that combines LV functional information from ultrasound with live x-ray fluoroscopy was developed. Two mean anatomical models, each containing LV epi-, LV endo- and right ventricle endocardial surfaces, were computed from a database of 33 heart failure patients as a substitute for a patient-specific model. The sphericity index was used to divide the observed population into two groups. The distance between the mean and the patient-specific models was determined using a signed distance field metric (reported in mm). The average error values for LV epicardium were [Formula: see text] and for LV endocardium were [Formula: see text]. The validity of using average LV models for a CRT procedure was tested by simulating coronary vein selection in a group of 15 CRT candidates. The probability of selecting the same coronary branch, when basing the selection on the average model compared to a patient-specific model, was estimated to be [Formula: see text]. This was found to be clinically acceptable.Keywords:
Endocardium
Coronary Vein
Sphericity
Lead (geology)
Coronary Vein
Cite
Citations (0)
Abstract Knowledge of the coronary sinus (CS) anatomy is crucial for implantation of cardiac resynchronization therapy (CRT). Obstacles to CS entry, such as the Eustachian ridge and Thebesian valve, as well as within the CS, such as Vieussen’s valve and the vein of Marshall, are important to understand and differentiate during implantation or to identify earlier by imaging. Anatomic knowledge is mandatory to select the most suitable side branch for lead implantation. Modern tools and techniques almost always enable other anatomic problems, such as tortuous, small, short, or overly straight side branches, to also be overcome.
Coronary anatomy
Coronary Vein
Cite
Citations (4)
Coronary Vein
Balloon catheter
Interventional cardiology
Cardiac catheterization
Cite
Citations (5)
We report on two patients treated with cardiac resynchronization therapy, in whom early (intra-operatively, 64-year-old man) and late (4 months post-operatively, 57-year-old woman) instability of the left ventricular (LV) lead occurred. In order to stabilize the electrodes, stents were deployed in both patients within the coronary sinus, into the space between the lead and the wall of the vein effectively pinning the lead to the wall. During 3 and 5 months of follow-up, the electrodes remained stable and allowed for successful resynchronization in both cases. Stenting within the coronary sinus seems to be a safe method for LV lead stabilization, which can substantially increase the success rate of resynchronization therapy. This new approach, although promising, has to prove its safety and should not be practised routinely until long-term follow-up data are available.
Coronary Vein
Lead (geology)
Cite
Citations (24)
Cardiac resynchronization utilizes left ventricular (LV) pacing through electrodes inserted through the coronary sinus (CS) into LV veins to stimulate the LV myocardium. Successful insertion of LV pacing leads requires an understanding of the anatomic changes associated with cardiac remodeling and a combination of standard pacing and cardiac catheterization and interventional techniques. CS catheterization and venography identify and access the target LV vein for insertion of the pacing lead. Obtaining an adequate lead position involves reaching appropriate capture thresholds, avoiding extra-cardiac stimulation, and stabilizing the lead to avoid dislodgement.
Coronary Vein
Great cardiac vein
Cardiac catheterization
Lead (geology)
Venography
Cardiac Pacing
Cite
Citations (16)
Cite
Citations (0)
Left ventricular lead placement in the appropriate branch of coronary sinus is the key to successful cardiac resynchronization therapy (CRT) and this step is technically challenging. We describe a case of non-ischemic cardiomyopathy with heart failure, taken up for cardiac resynchronization therapy with defibrillator (CRT-D) implantation. The quadripolar left ventricular lead was impossible to advance into the target lateral branch of the coronary sinus. We made a veno-venous loop, advancing the coronary guidewire through the middle cardiac vein to coronary sinus and then to superior vena cava. The guidewire then snared through the same left subclavian vein and exteriorized. Over this loop, the left ventricular lead of the CRT-D device was implanted successfully. This novel approach can be used to successfully implant the LV lead in difficult to implant situations, obviating the need for thoracotomy or other methods of LV lead implantation.
Coronary Vein
Thoracotomy
Cite
Citations (5)
Lead (geology)
Multidetector computed tomography
Cite
Citations (0)
Lead (geology)
Cite
Citations (0)