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Three-dimensional electroanatomic mapping of the coronary veins during cardiac resynchronization therapy implant: feasibility and possible applications

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Abstract

Purpose

Left ventricular (LV) electrical activation pattern could determine optimal LV lead placement site during cardiac resynchronization therapy (CRT) device implant. We sought to determine the feasibility of using EnSite NavX™ electroanatomic mapping system (St. Jude Medical Inc., St. Paul, MN) to assess LV electrical activation during CRT implant.

Methods

Patients (n = 32; NYHA III, LVEF <35 %, QRSd >120 ms) underwent NavX™ mapping during CRT implant. Left bundle branch block (LBBB) was present during sinus rhythm in group A (n = 17), whereas LBBB was induced by permanent RV apical pacing in group B (n = 15). Following coronary sinus (CS) cannulation, a coil tip 0.014-in. guidewire was introduced into all available CS branches as a mapping electrode. Each patient’s unipolar activation map was successfully constructed within 10 min, using the onset of surface QRS as reference.

Results

LV activation patterns were complex and varied in both groups. Earliest activation was usually apical, but latest activation was more heterogenous. The lateral or posterolateral branches were the sites of latest activation in 47 % of group A and 73 % of group B. An LV lead positioned conventionally by a physician blinded to the mapping data was concordant with the latest activated segment in 18 % of group A and none of group B patients.

Conclusions

Electroanatomic mapping of the CS tributaries is feasible and clinically practicable. Mapping revealed heterogenous conduction patterns that vary between patients in each group and between groups. An LV lead empirically placed in a lateral branch rarely paces the optimal, latest activated vein segment.

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Acknowledgments

The authors gratefully acknowledge Joe Grundle, Katie Klein, and Susan Nord of Aurora Cardiovascular Services for the editorial preparation of the manuscript and Brian Miller and Brian Schurrer of Aurora Sinai Medical Center for their help in preparing illustrations.

Conflict of interest

Dr. Niazi receives study grants and consulting fees for product development from and has stock in Medtronic Inc.; he receives consulting fees for product development from Osprey Medical Inc. and St. Jude Medical Inc.; he participates in research grants from Biotronik Inc., Boston Scientific Corp., Sanofi-Aventis, Janssen Pharmaceuticals, and Bristol-Myer Squibb Co.; and he participates in speaker bureaus for Sanofi-Aventis and Janssen Pharmaceuticals. Dr. Ryu and Mr. Hood are employed by St. Jude Medical. Dr. Choudhuri and Dr. Akhtar have no conflicts.

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Authors and Affiliations

  1. Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public Health, 2801 W. Kinnickinnic River Parkway, #840, Milwaukee, 53215, WI, USA

    Imran Niazi, Indrajit Choudhuri & Masood Akhtar

  2. St. Jude Medical, 15900 Valley View Court, Sylmar, 91342, CA, USA

    Kyungmoo Ryu & Richard Hood

Authors
  1. Imran Niazi
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  2. Kyungmoo Ryu
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  3. Richard Hood
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  4. Indrajit Choudhuri
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  5. Masood Akhtar
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Correspondence to Imran Niazi.

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Niazi, I., Ryu, K., Hood, R. et al. Three-dimensional electroanatomic mapping of the coronary veins during cardiac resynchronization therapy implant: feasibility and possible applications. J Interv Card Electrophysiol 41, 147–153 (2014). https://doi.org/10.1007/s10840-014-9932-9

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  • DOI: https://doi.org/10.1007/s10840-014-9932-9

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