Abstract 3522: Selection of the Latest LV Contration Site for LV Lead Placement Based on Integration of 3D TEE and CS Rotation Angiography Information
Background. The non-responder rate for cardiac resynchronisation therapy (CRT) averages around 25–30%. Recent retrospective data imply that patients had a better outcome if the LV lead stimulated the latest site of mechanical LV contraction. The present study for the first time attempted to prospectively implant the LV lead at the site of latest mechanical LV contraction.
Methods. 15 patients presenting with symptomatic heart failure (NYHA III–IV), SR and standard indication for CRT were included into the study (13 male, age 65+/−11 years, 10 DCM, 5 ICM, EF 24+/−7 %, LVEDD 65+/−8 mm, QRS 150+/−17 ms, NYHA 3+/−0.5). Prior to implantation patients received CS rotation angiography after femoral access. Parallel and with the catheters being inside the patient a 3D TEE was performed. From rotation angiography the CS venous tree was reconstructed three dimensionally. That information was fused with the echo data showing the 3D reconstruction of the LV geometry and simultaneously displaying information on timing of mechanical LV contraction in a colour coded fashion. Out of this 3D model the CS vein being closest to the site of latest mechanical LV contraction was selected as the target vein for implantation.
Results. The site of latest LV contraction was in a classical posterior/lateral position in 73% of the patients. In 27% the latest contraction was found in the anterior wall. The area of latest LV contraction was wider than expected covering in average 3+/−1 segments of the bulls-eye plot. In all patients an appropriate target vein was found adjacent to the site of latest LV contraction. Implantation could be performed in that vein in all patients. On clinical follow-up patients showed an increase in VO2max from 10 (8;15) to 18 (13;22) ml/kg/min and an increase in 6MWT from 268 (151;390) to 381 (284;523) m. BNP was reduced from 388 (146;1115) to 29 (13;86) ng/l.
Conclusion. Selection of a target vein for LV lead placement according to the site of latest mechanical LV contraction is feasible. Initial clinical follow-up data are promising. That approach could lead to an individualized CRT, where therapy is tailored to the individual patient’s need, and in return might have the potential to reduce rate of non-responder.