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Nuclear image-guided left ventricular pacing lead navigation feasibility of a new technique

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Current techniques for left ventricular (LV) lead implantation in patients with ischemic cardiomyopathy (ICM) typically underutilize information which is important for optimal lead location, including LV mechanical activation pattern and scar location. We sought to develop a technique in which this information, contained in single-photon emission computed tomographic (SPECT) images, could be integrated as to guide the electrophysiologist during the implantation procedure.

Methods

Five ICM patients underwent SPECT as well as multidetector cardiac computed tomographic (MDCT) imaging prior to the LV lead implantation procedure. Images were merged to create a “fusion” image, in which the SPECT data were projected onto the anatomically accurate MDCT epicardial surface. The fusion image was registered to the operative field using the coronary veins, apparent on the MDCT image, as a fiducial system. After registration, LV lead implantation was guided by the fusion image using a commercial catheter navigation system.

Results

Successful guidance was achieved in each patient, with minimal disturbance to standard workflow. Leads were implanted in late-activating, unscarred regions according to the fusion image, with locations corroborated by fluoroscopic and electrographic features. In regions where leads were contiguous to the phrenic nerve shown on the fusion image, pacing consistently demonstrated diaphragmatic stimulation.

Conclusions

In this technical report, the description and feasibility of a new technique for SPECT image-guided LV pacing lead navigation is demonstrated. Prospective study will be required to confirm image precision and registration/navigation accuracy, as well as to demonstrate value relative to standard implantation techniques.

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Conflict of interest

This work was performed without external funding. The investigators have the following disclosures:

Ludwig:

  • Consultant: QuantMD

  • Research grant support: none

Menon:

  • Founder and Chief Executive Officer of QuantMD

  • Research grant support: none

Schwartzman:

  • Consultant: Atricure, Inc.; Avery-Dennison, Inc.; Biosense, Inc. QuantMD LLC; and Epicardial Frontiers, LLC

  • Research grant support: Boston Scientific, Medtronic, St. Jude Medical

Author information

Authors and Affiliations

  1. Division of Radiology, University of Pittsburgh, Pittsburgh, PA, USA

    Daniel R. Ludwig

  2. QuantMD, LLC, Pittsburgh, PA, USA

    Prahlad G. Menon

  3. Heart, Lung and Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA

    David Schwartzman

Authors
  1. Daniel R. Ludwig
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  2. Prahlad G. Menon
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  3. David Schwartzman
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Corresponding author

Correspondence to David Schwartzman.

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Ludwig, D.R., Menon, P.G. & Schwartzman, D. Nuclear image-guided left ventricular pacing lead navigation feasibility of a new technique. J Interv Card Electrophysiol 44, 273–277 (2015). https://doi.org/10.1007/s10840-015-0046-9

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  • DOI: https://doi.org/10.1007/s10840-015-0046-9

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