Location, Location, Location: A Pilot Study to Compare Electrical with Echocardiographic-Guided Targeting of Left Ventricular Lead Placement in Cardiac Resynchronisation Therapy.
Panagiota A ChousouRahul K ChattopadhyayGareth D K MatthewsVassilios S VassiliouPeter J PughPublished in: Diagnostics (Basel, Switzerland) (2024)
Introduction: Cardiac resynchronisation therapy is ineffective in 30-40% of patients with heart failure with reduced ejection fraction. Targeting non-scarred myocardium by selecting the site of latest mechanical activation using echocardiography has been suggested to improve outcomes but at the cost of increased resource utilisation. The interval between the beginning of the QRS complex and the local LV lead electrogram (QLV) might represent an alternative electrical marker. Aims: To determine whether the site of latest myocardial electrical and mechanical activation are concordant. Methods: This was a single-centre, prospective pilot study, enrolling patients between March 2019 and June 2021. Patients underwent speckle-tracking echocardiography (STE) prior to CRT implantation. Intra-procedural QLV measurement and R-wave amplitude were performed in a blinded fashion at all accessible coronary sinus branches. Pearson's correlation coefficient and Cohen's Kappa coefficient were utilised for the comparison of electrical and echocardiographic parameters. Results: A total of 20 subjects had complete data sets. In 15, there was a concordance at the optimal site between the electrically targeted region and the mechanically targeted region; in four, the regions were adjacent (within one segment). There was discordance (≥2 segments away) in only one case between the two methods of targeting. There was a statistically significant increase in procedure time and fluoroscopy duration using the intraprocedural QLV strategy. There was no statistical correlation between the quantitative electrical and echocardiographic data. Conclusions: A QLV-guided approach to targeting LV lead placement appears to be a potential alternative to the established echocardiographic-guided technique. However, it is associated with prolonged fluoroscopy and overall procedure time.
Keyphrases
- left ventricular
- ejection fraction
- cardiac resynchronization therapy
- end stage renal disease
- cancer therapy
- pulmonary hypertension
- aortic stenosis
- hypertrophic cardiomyopathy
- left atrial
- mitral valve
- acute myocardial infarction
- heart failure
- chronic kidney disease
- prognostic factors
- coronary artery disease
- electronic health record
- peritoneal dialysis
- coronary artery
- stem cells
- clinical trial
- atrial fibrillation
- magnetic resonance
- mass spectrometry
- immune response
- climate change
- magnetic resonance imaging
- study protocol
- risk assessment
- data analysis
- cell therapy
- functional connectivity
- machine learning
- acute coronary syndrome