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

作者：Kumar Prabhat; Blendea Dan; Nandigam Veena; Moore Stephanie A; Heist E Kevin; Singh Jagmeet P^*

来源：Journal of Interventional Cardiac Electrophysiology, 2010, 29(1): 17-22.

DOI：10.1007/s10840-010-9497-1

• Cardiac resynchronization therapy
• Left ventricular lead position
• Chest x-ray
• Rotational coronary venous angiography

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.
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 55A degrees to LAO 55A degrees (120 frames). Conventional CXR method (CC) and a composite CXR strategy (CM) based on two-view CXR were separately compared with RCVA.
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 < 0.0001).
The composite CXR strategy is a useful method for post-procedure LV lead localization. Due to its simplicity, it can be widely applied in post-implant evaluation of LV lead position in CRT patients.

• 出版日期2010-10