Abstract 2887: The Best Angiographic View for Left Ventricular Lead Placement is Highly Variable Between Patients: A Rotational Coronary Venography Study
Background: High-speed rotational coronary venous angiography (RCVA) permits a dynamic, multi-angle visualization of the coronary venous (CV) tree.
Aim: To use RCVA to evaluate the best angiographic view to delineate anatomical regions of the CV system for left ventricular (LV) lead placement.
Methods: Digitally acquired RCVA from 39 patients (age 68±11 years, 31 men) undergoing LV lead implantation were analyzed. RCVA uses a rapid isocentric rotation over an 110° arc from RAO 55° to LAO 55°, acquiring 120 frames/angiogram. The best angiographic view was defined as the view that provided the least amount of vessel foreshortening and overlap.
Results: The most optimal angle for viewing different segments of the CV tree was variable between patients and spanned the full range of the 110° arc (Figure⇓). The most optimal angle had to be changed significantly to visualize each of the 3 critical stages for LV lead advancement, namely engagement of the CS, the turn from the CS into a first order tributary, and maneuvering the lead into its final position. For an implant in the posterior vein (PV) territory these angles were significantly different for each of the 3 stages, LAO 45±9° (CS), LAO 11±25° (CS-PV junction), and LAO 5±27° (PV branches), (p<0.0001). Similarly, for an implant in the LMV territory the angles for each stage were significantly different; LAO 45±9° (CS), LAO 1±20° (CS- LMV junction), and RAO 14±22° (LMV branches), (p<0.0001).
Conclusions: Rotational venography shows that the optimal view for LV lead placement is specific to the patient and the underlying CV anatomy, and may change depending on the part of the CV tree being evaluated.