Abstract 2507: Integrating Functional and Anatomical Information to Guide Cardiac Resynchronization Therapy using a Computed Heart Model
Background The optimal location for left ventricle (LV) lead placement during cardiac resynchronization therapy (CRT) is believed to be at the segment of maximal LV mechanical dyssynchrony. In patients receiving CRT, pre-procedural echocardiography can regionalize mechanical dyssynchrony while intra-procedural rotational angiography can delineate the coronary venous anatomy. This report details a practical method to integrate coronary venous anatomy with a volumetric echocardiographic image of regional ventricular dyssynchrony.
Methods 2D dyssynchrony maps from tissue-Doppler imaging were acquired before and after CRT (iE33/QLab, Philips Medical Systems), and projected in 3D onto LV epicardial shells (SH). During device implantation, 3D coronary venous angiography was performed using a rapid C-arm rotation covering a 110° arc (120 frames). 3D coronary vein models were computed and retrospectively registered with the SH using an anatomical heart model derived from a CT-scan database as an intermediate registration step.
Results In the case displayed, the baseline SH revealed delayed activation of the lateral wall compared to the septum. The LV lead was navigated into a lateral wall vein, resulting in improvement of LV synchrony and hemodynamic function (decreased mitral regurgitation and increased dP/dt from 565 to 826 mmHg/s).
Conclusion The fusion of pre-procedural echocardiography and intra-procedural venous angiography may identify the optimal LV segment to pace during CRT. Integration of this functional and anatomical information is clinically feasible using a computed heart model as an intermediate step in multimodality fusion.