Abstract 12553: Planning and Guidance of Cardiac Resynchronization Therapy Lead Implantation using Coronary Venous Anatomy with Multi-detector Computed Tomography
Introduction: Coronary venous anatomical variation can affect lead placement and may warrant pre-implantation visualization prior to cardiac resynchronization therapy. We sought to evaluate the utility of 64 detector multi-detector computerized tomography (MDCT) to visualize coronary venous anatomy for pre-operative planning and lead placement.
Methods: Prospective randomized enrollment of 23 patients (13 males;mean age 67.6 yrs) was undertaken. Patients were randomized to pre-implantation MDCT (GE Lightspeed, n=17) or no 64-CT (n=6). Implantation was planned based on 3D coronary venous reconstruction visualized in the MDCT group. Measurement of coronary sinus (CS) angulation, CS os diameter, right atrial dimensions was undertaken prior to implant. Intraoperative CS lead implantation times (introduction, cannulation and left ventricular positioning), procedure and fluoroscopy time, as well as venogram contrast volume were measured to determine if there was a difference between patients who underwent pre-implant MDCT scan and those who did not.
Results: Within the MDCT group, CS os diameter (mean=13.4±2.9 cm) was inversely correlated with CS lead implantation time (r = −0.39;p=0.13), total procedure time (r = −0.62, p =0.014), total fluoroscopy time (r=−0.81, p=.0003) and time to cannulation (r = −0.65, p=0.006). Greater CS angulation (mean = 64.4°± 9.4) was associated with shorter time to successful CS cannulation. There was no statistically significant difference between the CT group and the non CT group with respect to intraoperative and fluoroscopy times as well as venogram contrast volume.
Conclusions: Noninvasive visualization of the coronary venous anatomy before CRT implantation can be used to guide lead placement. While no significant differences were noted between the two groups, there still may be utility in obtaining MDCT to visualize coronary venous anatomy prior to CRT implantation for procedural planning and lead placement guidance.
- © 2010 by American Heart Association, Inc.