Location, location, location: A pilot study to compare electrical with echocardiographic-guided targeting of left ventricular lead placement in cardiac resynchronisation therapy

Chousou, Panagiota A., Chattopadhyay, Rahul K., Matthews, Gareth D. K. ORCID: https://orcid.org/0000-0001-8353-4806, Vassiliou, Vassilios S. ORCID: https://orcid.org/0000-0002-4005-7752 and Pugh, Peter J. (2024) Location, location, location: A pilot study to compare electrical with echocardiographic-guided targeting of left ventricular lead placement in cardiac resynchronisation therapy. Diagnostics, 14 (3). ISSN 2075-4418

[thumbnail of diagnostics-14-00299-v2]
Preview
PDF (diagnostics-14-00299-v2) - Published Version
Available under License Creative Commons Attribution.

Download (5MB) | Preview

Abstract

Introduction: Cardiac resynchronisation therapy is ineffective in 30–40% of patients with heart failure with reduced ejection fraction. Targeting non-scarred myocardium by selecting the site of latest mechanical activation using echocardiography has been suggested to improve outcomes but at the cost of increased resource utilisation. The interval between the beginning of the QRS complex and the local LV lead electrogram (QLV) might represent an alternative electrical marker. Aims: To determine whether the site of latest myocardial electrical and mechanical activation are concordant. Methods: This was a single-centre, prospective pilot study, enrolling patients between March 2019 and June 2021. Patients underwent speckle-tracking echocardiography (STE) prior to CRT implantation. Intra-procedural QLV measurement and R-wave amplitude were performed in a blinded fashion at all accessible coronary sinus branches. Pearson’s correlation coefficient and Cohen’s Kappa coefficient were utilised for the comparison of electrical and echocardiographic parameters. Results: A total of 20 subjects had complete data sets. In 15, there was a concordance at the optimal site between the electrically targeted region and the mechanically targeted region; in four, the regions were adjacent (within one segment). There was discordance (≥2 segments away) in only one case between the two methods of targeting. There was a statistically significant increase in procedure time and fluoroscopy duration using the intraprocedural QLV strategy. There was no statistical correlation between the quantitative electrical and echocardiographic data. Conclusions: A QLV-guided approach to targeting LV lead placement appears to be a potential alternative to the established echocardiographic-guided technique. However, it is associated with prolonged fluoroscopy and overall procedure time.

Item Type: Article
Additional Information: Funding Information: RK Chattopadhyay is supported by a Wellcome PhD Fellowship. G Matthews is supported by a NIHR clinical lectureship. No external funding was required for this project.
Uncontrolled Keywords: cardiac resynchronisation therapy,heart failure,left ventricular lead placement,qlv,radial strain echocardiography,clinical biochemistry ,/dk/atira/pure/subjectarea/asjc/1300/1308
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Science > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Norwich Epidemiology Centre
Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health
Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 28 May 2024 16:30
Last Modified: 28 May 2024 16:31
URI: https://ueaeprints.uea.ac.uk/id/eprint/95322
DOI: 10.3390/diagnostics14030299

Downloads

Downloads per month over past year

Actions (login required)

View Item View Item