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Implementation of a full cardiac magnetic resonance imaging (CMR) work-up to determine tissue characteristics at the site of the left ventricular (LV) lead in patients with ischaemic cardiomyopathy undergoing CRT.
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Implementation of a 36-segment bullseye plot to accurately delineate scarred myocardium.
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Pacing from scar-free segments results in a larger degree of reverse remodelling. A trend was seen towards superior reverse remodelling in patients with LV leads placed in a scar-free, late-contracting region (LCR) compared to pacing in a scar-free segment outside a LCR.
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This study provides further support for a role of CMR in real-time, guided LV lead deployment.
Introduction
Materials and methods
Patient selection
Study design
LV lead position
CMR analysis
Statistics
Results
Baseline characteristics
All patients | LV lead in scar-free region and LCR | LV lead in scar-free region, not in LCR | LV lead within scar | |
---|---|---|---|---|
Patient characteristics | (n =30) | (n =6) | (n =13) | (n =11) |
Age at implantation (years) | 69.9 ± 5.8 | 68 ± 7 | 72 ± 5 | 68 ± 6 |
Male gender, n (%) | 24 (80) | 4 (66.7) | 10 (76.9) | 10 (90.9) |
LBBB conduction, n (%) | 23 (76.7) | 5 (83.3) | 10 (76.9) | 8 (72.7) |
QRS duration (ms) | 150 ± 19 | 151 ± 29 | 146 ± 18 | 154 ± 14 |
NYHA, n (%) | ||||
I/II | 13 (43.3) | 2 (33.3) | 6 (46.2) | 5 (45) |
III/IV | 15 (50) | 3 (50) | 7 (53.8) | 5 (45) |
Scar burden, % (interquartile range) | 19 (14–24) | 13 (5–31) | 14 (12–22)* | 21 (18–44)* |
LV end-systolic volume (ml) | 151 ± 56 | 174 ± 79 | 143 ± 39 (p = 0.06) | 148 ± 62 |
LV end-diastolic volume (ml) | 198 ± 63 | 215 ± 91 | 193 ± 41 | 196 ± 72 |
LV ejection fraction (%) | 24.8 ± 7.0 | 20 ± 5 | 26 ± 7 | 26 ± 7* |
Comorbidities, n (%) | 10 (33.3) | |||
Atrial fibrillation | 9 (30) | 1 (16.7) | 5 (38.5) | 3 (27.3) |
Hypertension | 16 (53.3) | 5 (83.3) | 8 (61.5)* | 3 (27.3)* |
Smoking | 19 (63.3) | 5 (83.3) | 7 (53.8) | 7 (63.6) |
Medication, n (%) | ||||
Beta blocker | 21 (70) | 4 (66.7) | 11 (84.6) | 6 (54.5) |
ACE-i/ARB | 29 (96.7) | 5 (100) | 14 (100) | 10 (90.9) |
Diuretics | 25 (83.3) | 5 (83.3) | 12 (92.3) | 8 (72.7) |