title: Utility of echocardiographic tissue synchronization imaging to redirect left ventricular lead placement for improved cardiac resynchronization therapy.
abstract: An 80-year-old woman with severe symptomatic heart failure (ejection fraction of 13%), and left bundle branch block (QRS duration of 160 ms) underwent cardiac resynchronization therapy (CRT). She had significant baseline dyssynchrony with a septal to posterior wall delay of 160 ms by echocardiographic tissue synchronization imaging (TSI). Despite exhaustive efforts, a stable posterior-lateral coronary vein lead position could not be achieved with the standard percutaneous approach, resulting in anterior coronary vein lead placement. This resulted in no improvement in the patient's symptoms or ventricular function. Follow-up TSI revealed earlier activation of the anteroseptal site and worsened dyssynchrony with septal to posterior wall delay of now 290 ms. This information prompted surgical revision of the left ventricular (LV) lead position via limited thoracotomy and posterior-lateral epicardial lead implantation. Pacing at the new lead site resulted in a 30% increase in stroke volume and symptomatic improvement. TSI in this case redirected lead position in a clinical nonresponder, resulting in a favorable response to CRT.
authors.affiliation: University of Pittsburgh, Pittsburgh, Pennsylvania 15213-2582, USA.
authors.forename: Kaoru
authors.initials: K
authors.lastname: Dohi
authors.forename: Matthew
authors.initials: M
authors.lastname: Suffoletto
authors.forename: Leonard
authors.initials: L
authors.lastname: Ganz
authors.forename: Marco
authors.initials: M
authors.lastname: Zenati
authors.forename: John
authors.initials: J
authors.lastname: Gorcsan
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects / Q000379:methods*; D009202:Cardiomyopathies / Q000628:therapy; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans