Skip to main content
SpringerLink
Log in

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

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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 55° to LAO 55° (120 frames). Conventional CXR method (CC) and a composite CXR strategy (CM) based on two-view CXR were separately compared with RCVA.

Results

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).

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Abbreviations

CRT:

Cardiac resynchronization therapy

LV:

Left ventricle

RCVA:

Rotational coronary venous angiography

LAO:

Left anterior oblique

RAO:

Right anterior oblique

CS:

Coronary sinus

CXR:

Chest X-ray

CC:

Conventional CXR method

CM:

Composite CXR strategy

AA:

Anterior

AL:

Antero-lateral

LL:

Lateral

PL:

Postero-lateral

PP:

Posterior

References

  1. Cleland, J. G., Daubert, J. C., Erdmann, E., Freemantle, N., Gras, D., Kappenberger, L., et al. (2005). The effect of cardiac resynchronization on morbidity and mortality in heart failure. The New England Journal of Medicine, 352, 1539–1549.

    Article  CAS  PubMed  Google Scholar 

  2. Cleland, J. G., Daubert, J. C., Erdmann, E., Freemantle, N., Gras, D., Kappenberger, L., et al. (2006). Longer-term effects of cardiac resynchronization therapy on mortality in heart failure [the CArdiac REsynchronization-Heart Failure (CARE-HF) trial extension phase]. European Heart Journal, 27, 1928–1932.

    Article  PubMed  Google Scholar 

  3. Bristow, M. R., Saxon, L. A., Boehmer, J., Krueger, S., Kass, D. A., De Marco, T., et al. (2004). Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. The New England Journal of Medicine, 350, 2140–2150.

    Article  CAS  PubMed  Google Scholar 

  4. Abraham, W. T., Fisher, W. G., Smith, A. L., Delurgio, D. B., Leon, A. R., Loh, E., et al. (2002). Cardiac resynchronization in chronic heart failure. The New England Journal of Medicine, 346, 1845–1853.

    Article  PubMed  Google Scholar 

  5. Becker, M., Hoffmann, R., Schmitz, F., Hundemer, A., Kuhl, H., Schauerte, P., et al. (2007). Relation of optimal lead positioning as defined by three-dimensional echocardiography to long-term benefit of cardiac resynchronization. The American Journal of Cardiology, 100, 1671–1676.

    Article  PubMed  Google Scholar 

  6. Nagele, H., Hashagen, S., Azizi, M., Behrens, S., & Castel, M. A. (2006). Long-term hemodynamic benefit of biventricular pacing depending on coronary sinus lead position. Herzschrittmachertherapie & Elektrophysiologie, 17, 185–190.

    Article  CAS  Google Scholar 

  7. Ypenburg, C., van Bommel, R. J., Delgado, V., Mollema, S. A., Bleeker, G. B., Boersma, E., et al. (2008). Optimal left ventricular lead position predicts reverse remodeling and survival after cardiac resynchronization therapy. Journal of the American College of Cardiology, 52, 1402–1409.

    Article  PubMed  Google Scholar 

  8. Rovner, A., de Las Fuentes, L., Faddis, M. N., Gleva, M. J., Davila-Roman, V. G., & Waggoner, A. D. (2007). Relation of left ventricular lead placement in cardiac resynchronization therapy to left ventricular reverse remodeling and to diastolic dyssynchrony. The American Journal of Cardiology, 99, 239–241.

    Article  PubMed  Google Scholar 

  9. Becker, M., Kramann, R., Franke, A., Breithardt, O. A., Heussen, N., Knackstedt, C., et al. (2007). Impact of left ventricular lead position in cardiac resynchronization therapy on left ventricular remodelling. A circumferential strain analysis based on 2D echocardiography. European Heart Journal, 28, 1211–1220.

    Article  PubMed  Google Scholar 

  10. Blendea, D., Mansour, M., Shah, R. V., Chung, J., Nandigam, V., Heist, E. K., et al. (2007). Usefulness of high-speed rotational coronary venous angiography during cardiac resynchronization therapy. The American Journal of Cardiology, 100, 1561–1565.

    Article  PubMed  Google Scholar 

  11. Blendea, D., Shah, R. V., Auricchio, A., Nandigam, V., Orencole, M., Heist, E. K., et al. (2007). Variability of coronary venous anatomy in patients undergoing cardiac resynchronization therapy: a high-speed rotational venography study. Heart Rhythm, 4, 1155–1162.

    Article  PubMed  Google Scholar 

  12. Knackstedt, C., Muhlenbruch, G., Mischke, K., Bruners, P., Schimpf, T., Frechen, D., et al. (2008). Imaging of the coronary venous system: validation of three-dimensional rotational venous angiography against dual-source computed tomography. Cardiovascular and Interventional Radiology, 31, 1150–1158.

    Article  PubMed  Google Scholar 

Download references

Disclosures for potential conflicts of interest

Prabhat Kumar: no potential conflicts of interest; Dan Blendea: no potential conflicts of interest; Veena Nandigam: no potential conflicts of interest; Stephanie Moore receives honoraria from Boston Scientific Corp. and research grants from St. Jude Medical; E. Kevin Heist receives honoraria from Biotronik, Boston Scientific Corp., Medtronic, St. Jude Medical and Sorin group; receives research grants from Biotronik, St. Jude Medical (all modest) and is consultant to St Jude Medical; Jagmeet P Singh has received research grants from St. Jude Medical, Medtronic Inc., Boston Scientific Corp. and Biotronik; has received Honoraria / Speaker Fees from Medtronic Inc., Biotronik, Guidant Corp., St. Jude Medical and has served on advisory Board/Steering Committee and as Consultant to Boston Scientific Corp., Biotronik, St. Jude Medical, Medtronic, Philips Medical Systems. No stocks/No speakers bureau.

Author information

Authors and Affiliations

  1. Cardiac Arrhythmia Service, GRB 109 Massachusetts General Hospital Heart Center, Harvard Medical School, 55 Fruit Street, Boston, MA, 02412, USA

    Prabhat Kumar, Dan Blendea, Veena Nandigam, Stephanie A. Moore, E. Kevin Heist & Jagmeet P. Singh

Authors
  1. Prabhat Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dan Blendea
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Veena Nandigam
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephanie A. Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Kevin Heist
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jagmeet P. Singh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jagmeet P. Singh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kumar, P., Blendea, D., Nandigam, V. et al. Assessment of the post-implant final left ventricular lead position: a comparative study between radiographic and angiographic modalities. J Interv Card Electrophysiol 29, 17–22 (2010). https://doi.org/10.1007/s10840-010-9497-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-010-9497-1

Keywords

Search

Navigation