Real-Time X-MRI-Guided Left Ventricular Lead Implantation for Targeted Delivery of Cardiac Resynchronization Therapy

JACC. Clinical Electrophysiology
Jonathan M BeharChristopher Aldo Rinaldi

Abstract

This study sought to test the feasibility of a purpose-built, integrated software platform to process, analyze, and overlay cardiac magnetic resonance (CMR) data in real time within a combined cardiac catheter laboratory and magnetic resonance imaging scanner suite (X-MRI) to guide left ventricular (LV) lead implantation. Suboptimal LV lead position is a major determinant of poor cardiac resynchronization therapy (CRT) response, and the optimal site is highly patient specific. Pacing myocardial scar is associated with poorer outcomes; conversely, targeting latest mechanical activation (LMA) may improve them. Fourteen patients (age 74 ± 5.1 years; New York Heart Association functional class: 2.7 ± 0.4; 86% ischemic with ejection fraction 27 ± 7.6%; QRSd: 157 ± 19 ms) underwent CMR followed by immediate CRT implantation using derived scar and dyssynchrony data, overlaid onto fluoroscopy in an X-MRI suite. Rapid LV segmentation enabled detailed scar quantification, identification of LMA segments, and selection of myocardial targets. At coronary venography, the CMR-derived 3-dimensional shell was fused, enabling identification of viable venous targets subtended by target segments for LV lead placement. The platform was successful i...Continue Reading

Citations

Mar 9, 2019·The International Journal of Cardiovascular Imaging·Odette A E SaldenMathias Meine
Apr 25, 2020·Pacing and Clinical Electrophysiology : PACE·Baldeep S SidhuChristopher A Rinaldi
Jan 19, 2020·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·W A GathierF J van Slochteren
May 1, 2020·European Heart Journal. Case Reports·Akinori MatsumotoAya Inakami
Apr 1, 2018·International Journal of Computer Assisted Radiology and Surgery·Maria PanayiotouKawal S Rhode
Jul 19, 2018·Expert Review of Medical Devices·Benjamin J SieniewiczChristopher A Rinaldi
Oct 20, 2018·Minerva medica·Jeremy Moskovitch, Aleksandr Voskoboinik
Aug 9, 2018·Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation·A H Maass, S C Yap
Jan 24, 2021·Journal of Cardiovascular Electrophysiology·Justin GouldChristopher A Rinaldi
May 4, 2021·Arrhythmia & Electrophysiology Review·Baldeep S SidhuChristopher A Rinaldi
Oct 26, 2021·Herz·Mark K ElliottChristopher A Rinaldi

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