Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT

Boogers, Mark J.; Chen, Ji; Bommel, Rutger J. van; Borleffs, C. Jan Willem; Dibbets‐Schneider, Petra; Hiel, Bernies van der; Younis, Imad Al; Schalij, Martin J.; Wall, Ernst E. van der; Garcia, Ernest; Bax, Jeroen J.

doi:10.1007/s00259-010-1621-z

Cited by 107 publications

(69 citation statements)

References 27 publications

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“…In a retrospective study conducted by Boogers et al, 13 All patients had a QRS ≥120 ms. They found that, compared with nonresponders, responders showed lower LVESV, LV dyssynchrony and myocardial scar burden.…”

Section: Spect Mpimentioning

confidence: 99%

“…[8][9] Several myocardial imaging techniques have been developed to identify this position, such as echocardiography, [10][11] cardiac magnetic resonance imaging (CMR) 12 and nuclear imaging. [13][14][15] Placing the LV lead in the recommended position through coronary veins is a challenge. 16,17 This procedure requires high accuracy, since a difference of 20 mm in LV lead location on the myocardial wall can influence CRT response, and an incorrect LV lead pacing site may lead to greater myocardial dyssynchrony.…”

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confidence: 99%

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A Review of Image-guided Approaches for Cardiac Resynchronisation Therapy

Tang

Zhou

2017

Arrhythmia &Amp; Electrophysiology Review

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Device TherapyAccess at: www.AERjournal.com Cardiac resynchronisation therapy (CRT) is a widely-performedstandard treatment for improving cardiac function and quality of life in patients with heart failure.1 After CRT, however, 30-40 % of patients do not experience improvements in left ventricular (LV) function and clinical symptoms. [2][3] The key factors for increasing the response rate to CRT are identification of the optimal LV lead position and accurate lead placement at the optimal site. 4-7The optimal LV lead position is in the viable myocardial region with the latest contraction onset. [8][9] Several myocardial imaging techniques have been developed to identify this position, such as echocardiography, [10][11] cardiac magnetic resonance imaging (CMR) 12 and nuclear imaging. 13-15Placing the LV lead in the recommended position through coronary veins is a challenge. 16,17 This procedure requires high accuracy, since a difference of 20 mm in LV lead location on the myocardial wall can influence CRT response, and an incorrect LV lead pacing site may lead to greater myocardial dyssynchrony. 18This paper reviews the technical advances and clinical studies being used in image-guided LV lead placement in CRT, including the identification of optimal LV lead position and placement of the LV lead at the recommended site. Image-guided LV Lead Placement in CRT Optimal LV Lead PositionMyocardial viability at the LV lead position is a key factor in enhancing CRT response rate. that the U-shaped activation pattern induced by true LBBB and a QRS duration of ≥120 ms could be used as criteria to predict CRT response.Pacing the latest mechanical activated site may significantly reduce the total LV electromechanical activation time compared with pacing other sites on the myocardial wall. 17 An animal study demonstrated that the regions with maximal resynchronisation after CRT had maximum improvements in systolic LV function. These regions are the 'sweet spots' and regarded as optimal regions for LV lead placement. 33,34A recent study shows that the latest activated regions may vary AbstractCardiac resynchronisation therapy (CRT) is a standard treatment for patients with heart failure; however, the low response rate significantly reduces its cost-effectiveness. A favourable CRT response primarily depends on whether implanters can identify the optimal left ventricular (LV) lead position and accurately place the lead at the recommended site. Myocardial imaging techniques, including echocardiography, cardiac magnetic resonance imaging and nuclear imaging, have been used to assess LV myocardial viability and mechanical dyssynchrony, and deduce the optimal LV lead position. The optimal position, presented as a segment of the myocardial wall, is then overlaid with images of the coronary veins from fluoroscopy to aid navigation of the LV lead to the target venous site. Once validated by large clinical trials, these image-guided techniques for CRT lead placement may have an impact on current clinical practice.

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Section: Spect Mpimentioning

confidence: 99%

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confidence: 99%

A Review of Image-guided Approaches for Cardiac Resynchronisation Therapy

Tang

Zhou

2017

Arrhythmia &Amp; Electrophysiology Review

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“…There was no association between lead position in viable myocardium and persistent dyssynchrony by echocardiography, but pacemaker leads in all CRT responders were positioned in viable areas. A study in 90 HF patients with SyncTool [59] demonstrated that patients with lead placement concordant with the site of latest mechanical activation had a significantly higher response rate (n = 90, concordant: RSP = 79 %; discordant: RSP = 26 %), exhibiting significant LV systolic function improvement (assessed by echocardiography) at 6-month follow-up, while patients with discordant lead placement showed no significant improvement. To properly account for these factors, a comprehensive approach to CRT patient selection may be needed that combines phase analysis and myocardial scar evaluation, the latter both to assess overall scar burden and to evaluate myocardial viability at possible pacing sites.…”

Section: Crt and Patient Selection Optimizationmentioning

confidence: 99%

Imaging cardiac dyssynchrony

Kriekinge

Germano

2013

Clin Transl Imaging

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Myocardial perfusion imaging (MPI) has become a preeminent molecular imaging technique to assess ventricular mechanical dyssynchrony. In this article, we outline the motivation for the assessment of dyssynchrony, briefly review the application of echocardiographic and other non-nuclear imaging techniques for that purpose, and detail the technical aspects and validation of phase analysis by gated single-photon computed emission tomography and positron emission tomography. We also briefly outline differences between phase analysis of MPI and radionuclide angiography. Clinical applications are then reviewed, focusing on cardiac resynchronization therapy.

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“…There is now a growing literature on the uses of MPS in cardiac failure. In addition to providing information on perfusion, it can give an accurate assessment of both systolic and diastolic left ventricular function, including phase and movement asynchrony which, in conjunction with CT anatomy information from hybrid imaging, can be used in planning for positioning of various intracardiac devices [22][23][24][25]. Another potential growth area in nuclear cardiac imaging is SPECT blood pool imaging.…”

Section: Software Developmentsmentioning

confidence: 99%

Myocardial perfusion scintigraphy: past, present and future

Notghi

Low²

2011

BJR

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ABSTRACT. During the last two decades, radionuclide myocardial perfusion scintigraphy (MPS) has become established as the main functional cardiac imaging technique for the assessment of ischaemic heart disease (IHD). Despite a growing number of alternative functional imaging techniques, MPS still remains the most widely used technique, with a wealth of literature supporting its usefulness in assessing IHD and predicting prognosis. The technique itself has evolved, making it more reliable and robust, with additional ventricular functional information that further defines the prognosis in these patients. With the advent of hybrid single photon emission with CT and positron emission tomography with CT cameras together with the development of new camera technology that enables faster images with less radiation and better resolution, MPS will remain an essential part of IHD investigation. There are new promising radiopharmacological developments and applications such as radiolabelled fatty acids and metaiodobenzylguanidine. These will widen the scope of nuclear medicine imaging to include patients with cardiac failure and acute chest pain presenting to accident and emergency departments. Nuclear medicine cardiac investigations will continue to have an essential role in the diagnosis, stratification and prognosis of patients with cardiac disease, complementing the new developing cardiac modalities such as CT coronary angiography and MRI.

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Optimal left ventricular lead position assessed with phase analysis on gated myocardial perfusion SPECT

Cited by 107 publications

References 27 publications

A Review of Image-guided Approaches for Cardiac Resynchronisation Therapy

A Review of Image-guided Approaches for Cardiac Resynchronisation Therapy

Imaging cardiac dyssynchrony

Myocardial perfusion scintigraphy: past, present and future

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