Assessment of the post-implant final left ventricular lead position: a comparative study between radiographic and angiographic modalities

Purpose Post-implant lateral and postero-anterior chest X-rays (CXR) are often utilized to determine the final LV lead tip position after cardiac resynchronization therapy (CRT). This study sought to compare post-implant standard CXRs with intra-procedural rotational coronary venous angiography (RCV...

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Bibliographic Details
Published in:Journal of interventional cardiac electrophysiology 2010-10, Vol.29 (1), p.17-22
Main Authors: Kumar, Prabhat, Blendea, Dan, Nandigam, Veena, Moore, Stephanie A., Heist, E. Kevin, Singh, Jagmeet P.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Atrial Fibrillation - complications
Atrial Fibrillation - diagnostic imaging
Atrial Fibrillation - therapy
Cardiac Pacing, Artificial - methods
Cardiac Resynchronization Therapy - methods
Cardiology
Chi-Square Distribution
Cohort Studies
Coronary Angiography - methods
Electrodes, Implanted
Female
Follow-Up Studies
Heart Failure - complications
Heart Failure - diagnosis
Heart Failure - therapy
Heart Ventricles
Humans
Male
Medicine
Medicine & Public Health
Middle Aged
Pacemaker, Artificial
Radiography, Thoracic - methods
Risk Assessment
Treatment Outcome
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Summary:Purpose Post-implant lateral and postero-anterior chest X-rays (CXR) are often utilized to determine the final LV lead tip position after cardiac resynchronization therapy (CRT). This study sought to compare post-implant standard CXRs with intra-procedural rotational coronary venous angiography (RCVA) to localize the final LV lead position. Methods Sixty-four patients undergoing CRT (69.2 ± 11.4 years; males 68.7%; ischemic cardiomyopathy 59.4%; NYHA class 2.9 ± 0.5 and LV ejection fraction 24% ± 9%) were included in the study. RCVA was done by recording a rapid 4-second isocentric cine-loop from RAO 55° to LAO 55° (120 frames). Conventional CXR method (CC) and a composite CXR strategy (CM) based on two-view CXR were separately compared with RCVA. Results The most common pacing site was lateral (64.1%), followed by postero-lateral (23.4%) and antero-lateral (10.9%). In 73.4% (47) cases, the LV lead position was misclassified by CC as compared to RCVA. Among the 47 (73.4%) cases misclassified by CC approach, 35 had lateral LV lead position misclassified by CC as postero-lateral (77%), posterior (20%) and antero-lateral (3%). On the other hand, CM strategy classified the LV lead position correctly in 46 (71.9%) of the patients ( p  
ISSN:1383-875X
1572-8595
DOI:10.1007/s10840-010-9497-1