title: Assessment of the post-implant final left ventricular lead position: a comparative study between radiographic and angiographic modalities.
abstract: OBJECTIVE
  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.
authors.affiliation: Cardiac Arrhythmia Service, GRB 109 Massachusetts General Hospital Heart Center, Harvard Medical School, 55 Fruit Street, Boston, MA 02412, USA.
authors.forename: Prabhat
authors.initials: P
authors.lastname: Kumar
authors.forename: Dan
authors.initials: D
authors.lastname: Blendea
authors.forename: Veena
authors.initials: V
authors.lastname: Nandigam
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Moore
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Heist
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D016009:Chi-Square Distribution; D015331:Cohort Studies; D017023:Coronary Angiography / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D013902:Radiography, Thoracic / Q000379:methods*; D018570:Risk Assessment; D016896:Treatment Outcome