Left Ventricular Lead Placement Targeted at the Latest Activated Site Guided by Electrophysiological Mapping in Coronary Sinus Branches Improves Response to Cardiac Resynchronization Therapy

Abstract

LV lead placed at the latest activated site guided by EPM resulted in a significantly greater CRT response, and a shorter QRS duration.

Three‐Dimensional Electroanatomic Mapping System‐Enhanced Cardiac Resynchronization Therapy Device Implantation: Results From a Multicenter Registry

“…A suboptimal LV pacing site is one of the reasons for nonresponse to CRT . Several studies have suggested that pacing the LV in a site with late activation (either mechanical or electrical) may improve the hemodynamic response, reverse remodeling and clinical outcome of CRT recipients . Zanon et al .…”

Coronary sinus lead delay index for optimization of coronary sinus lead placement

“…Different pacing algorithms to reduce intraventricular, interventricular, and atrioventricular dyssynchrony is a continuous field of research in postimplantation period. Regarding implantation factors, position of CS lead and its proximity to the latest activated LV area was found to be a very important factor for CRT response (Liang et al., ; Rad et al., ).…”

Guidewire Method for Measuring Local Left Ventricular Electrical Activation Time During Cardiac Resynchronization Implantation

“…Studies that have prospectively measured QLV have thus far used 3D mapping systems or have moved the permanent LV pacing lead from site to site. [5][6][7][8]12 The present study describes a simplified method to measure QLV intervals using a unipolar guidewire during CRT implantation that does not require pairing with a 3D mapping system or repeated maneuvering of an LV pacing lead. The QLV measured with the guidewire corresponds closely with the value measured following placement of the lead.…”

“…This study was not designed or powered to follow patients for clinical response, since the relationship between QLV and CRT response rate is well established. 3,8 The present study did not seek to identify the site of the longest QLV in each patient, but sites with a QLV > 95 ms were identified in 19 out of 20 patients. This study nonetheless demonstrates the feasibility of making QLV measurements without an electroanatomic mapping system and prior to the selection of the final LV pacing lead.…”

“…Guidewire Method for Measuring Local LV Electrical Activation Time using three-dimensional (3D) mapping systems in conjunction with a guidewire, [5][6][7] and with LV pacing leads 8 ; however, this method is limited in that it can only be used by those electrophysiology (EP) laboratories with access to such systems and those who can afford the additional cost and time associated with 3D mapping. To determine if QLV measurements can be made before lead selection and without a 3D mapping system, electrogram recordings were made using a guidewire and a standard EP laboratory recording system, and then compared with recordings obtained from permanent LV pacing electrodes implanted at the same site.…”