Prospective randomized trial of venous cardiac computed tomographic angiography for facilitation of cardiac resynchronization therapy.
BACKGROUND
Cardiovascular computed tomographic angiography (CTA) can visualize the coronary veins. We sought to assess the ability of CTA to facilitate resynchronization therapy (CRT) procedures using a prospective randomized single-center pilot study.


METHODS
Patients underwent CTA for characterization of cardiomyopathy prior to biventricular implantable cardiac-defibrillator implant. Randomization was performed with operator review of the CTA for coronary venous anatomy prior to CRT in one-half of the cases. Invasive coronary venous angiograms were used in all procedures. Analysis included procedure times and utilization of contrast, fluoroscopy, and guide catheters.


RESULTS
Characteristics of the 26 patients enrolled were mean age 55 ± 11 years, male 76.9%, ischemic etiology 35%, ejection fraction 25 ± 3%, class III congestive heart failure 100%, and QRS duration 179 ± 29 ms. Of patients enrolled, 22 had both CTA and procedure initiation. Three patients (two with CTA review and one without CTA review) had aborted procedures due to hemodynamic issues. Analysis of the 22 patients (nine with preprocedure CTA review and 13 without CTA review) demonstrated that preprocedure review of CTA coronary venous anatomy led to significantly decreased procedure times and utilization of contrast, fluoroscopy, and guide catheters.


CONCLUSIONS
Preprocedure review of CTA coronary venous anatomy may lead to decreased procedural times and utilization of contrast, fluoroscopy, and guide catheters. These preliminary results will need to be evaluated in larger heart failure populations undergoing CRT.
Girsky
Marc J
MJ
Division of Cardiology, Harbor-UCLA Research and Education Institute, 1124 W Carson Street, Torrance, CA 90502, USA.
Shinbane
Jerold S
JS
Ahmadi
Naser
N
Mao
Songshou
S
Flores
Ferdinand
F
Budoff
Matthew J
MJ
D000328:Adult; D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D009202:Cardiomyopathies / Q000000981:diagnostic imaging / Q000628:therapy*; D017023:Coronary Angiography / Q000379:methods*; D017147:Defibrillators, Implantable; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000628:therapy*; D010865:Pilot Projects; D011446:Prospective Studies; D013318:Stroke Volume; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome