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Lack of agreement between mechanically and electrically defined optimal left ventricular lead placement target sites

Session Poster session 3

Speaker Kamil Sedlacek

Event : EHRA 2017

  • Topic : arrhythmias and device therapy
  • Sub-topic : Cardiac Resynchronization Therapy
  • Session type : Poster Session

Authors : K Sedlacek (Prague,CZ), D Wichterle (Prague,CZ), R Kockova (Prague,CZ), J Kautzner (Prague,CZ)

K Sedlacek1 , D Wichterle1 , R Kockova1 , J Kautzner1 , 1IKEM - Prague - Czech Republic ,

Europace ( 2017 ) 19 ( Supplement 3 ), iii330

Outcomes after cardiac resynchronization therapy (CRT) are influenced by an interaction between the myocardial substrate and the left ventricular lead position. Recent research has demonstrated that a combination of mechanichal dyssynchrony as assessed by cardiac magnetic resonance (CMR) and electrophysiologically guided left-ventricular lead placement show promising predictive strength for optimal CRT outcomes. However, little is known about the relationship between CMR-identified late contracting sites and electrically mapped late areas.
Methods: The study population consisted of 45 patients (age 63±12y, 71% males) undergoing CRT implantation during 2011-2014. All patients underwent CMR on 1.5 Tesla Siemens scanner including tagging sequence in basal, mid and apical short axis with strain analysis. The target segment for lead implantation was defined as the latest site of mechanical contraction on CMR with < 25% myocardial scar determined by the late gadolinium enhancement. The QLV (lateness of the left ventricular lead signal within the left ventricular electrical activation, measured as the interval between the QRS onset of surface ECG and intrinsicoid deflection on the bipolar sensing signal from the left-ventricular lead) was collected and related to the baseline QRS width (QLV ratio = QLV/baseline QRS width). Left ventricular contraction interval was defined as a delay between the time of left ventricular contraction at the site of LV lead segment and the most delayed left ventricular segment defined by the CMR.
Results: As shown in Figure 1, there was virtually no correlation between electrically defined left ventricular lead position (QLV ratio) and target lead segment as identified by the CMR (R 0.21, P = 0.2). Specifically, optimal left ventricular lead sites as defined by high values of QLV ratio were mostly distant from the optimal mechanically late segments defined by the CMR.
Conclusions: Contrary to the results of some previous studies, we found poor correlation between the indices of electrically mapped target left ventricular lead placement site and target sites identified by the CMR.

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