2010
DOI: 10.1111/j.1540-8167.2009.01663.x
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Simultaneous Electrical and Mechanical Mapping Using 3D Cardiac Mapping System: Novel Approach for Optimal Cardiac Resynchronization Therapy

Abstract: Cardiac resynchronization therapy (CRT) restores synchrony in heart failure patients. However, a significant proportion of patients implanted with CRT devices do not realize any benefit from CRT. Placing a left ventricular (LV) lead at the sites of electrical or mechanical delay has been advocated to maximize response to CRT, but there is currently no technique described to measure mechanical delay in real-time. We describe a novel technique that can be used intraoperatively to assess mechanical and electrical… Show more

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Cited by 28 publications
(12 citation statements)
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“…Median procedural time was 140 (122-180) minutes (average 158 minutes) and did not significantly differ compared with EAMS-guided procedures (P = 0.13). Coronary sinus angiography rate (83%) and median fluoroscopy time (median 16 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] minutes, average 20 minutes, mean DAP 88114 cGy*cm 2 ) were significantly higher than EAMS-guided procedures (P < 0.001 and P < 0.001, respectively). The LV lead was successfully implanted in 242 (97%) patients and complications were observed in 17 (7%) including CS dissection (N = 7), dislodgment of the atrial (N = 1) or LV lead (N = 4) requiring repositioning, pocket hematoma (N = 2), pocket infection (N = 1), and acute kidney failure (N = 2).…”
Section: Comparison Between Eams-guided and Traditional Crt-implantationmentioning
confidence: 99%
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“…Median procedural time was 140 (122-180) minutes (average 158 minutes) and did not significantly differ compared with EAMS-guided procedures (P = 0.13). Coronary sinus angiography rate (83%) and median fluoroscopy time (median 16 [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] minutes, average 20 minutes, mean DAP 88114 cGy*cm 2 ) were significantly higher than EAMS-guided procedures (P < 0.001 and P < 0.001, respectively). The LV lead was successfully implanted in 242 (97%) patients and complications were observed in 17 (7%) including CS dissection (N = 7), dislodgment of the atrial (N = 1) or LV lead (N = 4) requiring repositioning, pocket hematoma (N = 2), pocket infection (N = 1), and acute kidney failure (N = 2).…”
Section: Comparison Between Eams-guided and Traditional Crt-implantationmentioning
confidence: 99%
“…28 Recently, the first experiences of CRT devices implantation guided by EAMS have been published. [17][18][19][20][21][22][23][24] The preliminary findings of these studies indicated that this approach significantly reduces radiation exposure and may even allow fluoroscopy to be completely avoided. 24 However, the question arises as to whether these results are generalizable to centers with little or no experience of the "EAMS-guided" CRT implantation technique and whether reducing the X-ray dose results in increased procedure time and higher failure rates.…”
Section: Fluoroscopy Time Reductionmentioning
confidence: 99%
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“…Moreover, studies performed with electroanatomic mapping have shown that the extent of electrical delay at a particular site can be different among the different branches of the cardiac venous tree and even at different segments of a cardiac vein. 22,23 The quadripolar lead evaluated in this study allows LV pacing from each of the four electrodes as a cathode of stimulation up to 10 different pacing configurations and is able to pace in four anatomical segments separated by at least 4.7 cm. This wide separation between electrodes permits pacing from different longitudinal segments in the left ventricle.…”
Section: Discussionmentioning
confidence: 99%
“…[94][95][96] These modalities, combined with advanced echocardiographic evaluation of mechanical dyssynchrony such as color tissue Doppler imaging and 3-dimensional echocardiography, can be used to better understand the relationship between electrical and mechanical dyssynchrony. Direct comparison of electrical activation patterns with patterns of mechanical dyssynchrony will be important in understanding electromechanical interactions to improve patient selection and to optimize pacing strategies for maximal response to CRT.…”
Section: Patient Selection and Lead Placement For Crtmentioning
confidence: 99%