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

摘要

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 degrees to LAO 55 degrees (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.