title: Positioning of left ventricular pacing lead guided by intracardiac echocardiography with vector velocity imaging during cardiac resynchronization therapy procedure.
abstract: BACKGROUND
  Intraoperative modality for "real-time" left ventricular (LV) dyssynchrony quantification and optimal resynchronization is not established. This study determined the feasibility, safety, and efficacy of intracardiac echocardiography (ICE), coupled with vector velocity imaging (VVI), to evaluate LV dyssynchrony and to guide LV lead placement at the time of cardiac resynchronization therapy (CRT) implant.
  
  
  METHODS
  One hundred and four consecutive heart failure patients undergoing ICE-guided (Group 1, N = 50) or conventional (Group 2, N = 54) CRT implant were included in the study. For Group 1 patients, LV dyssynchrony and resynchronization were evaluated by VVI including visual algorithms and the maximum differences in time-to-peak (MD-TTP) radial strain. Based on the findings, the final LV lead site was determined and optimal resynchronization was achieved. CRT responders were defined using standard criteria 6 months after implantation.
  
  
  RESULTS
  Both groups underwent CRT implant with no complications. In Group 1, intraprocedural optimal resynchronization by VVI including visual algorithms and MD-TTP was a predictor discriminating CRT response with a sensitivity of 95% and specificity of 89%. Use of ICE/VVI increased number of and predicted CRT responders (82% in Group 1 vs 63% in Group 2; OR = 2.68, 95% CI 1.08-6.65, P = 0.03).
  
  
  CONCLUSIONS
  ICE can be safely performed during CRT implantation. "Real-time" VVI appears to be helpful in determining the final LV lead position and pacing mode that allow better intraprocedural resynchronization. VVI-optimized acute resynchronization predicts CRT response and this approach is associated with higher number of CRT responders.
authors: Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA.
authors: Rong
authors: R
authors: Bai
authors: Luigi
authors: L
authors: Di Biase
authors: Prasant
authors: P
authors: Mohanty
authors: Aaron B
authors: AB
authors: Hesselson
authors: Ermenegildo
authors: E
authors: De Ruvo
authors: Peter L
authors: PL
authors: Gallagher
authors: Claude S
authors: CS
authors: Elayi
authors: Sanghamitra
authors: S
authors: Mohanty
authors: Javier E
authors: JE
authors: Sanchez
authors: J David
authors: JD
authors: Burkhardt
authors: Rodney
authors: R
authors: Horton
authors: G Joseph
authors: GJ
authors: Gallinghouse
authors: Shane M
authors: SM
authors: Bailey
authors: Jason D
authors: JD
authors: Zagrodzky
authors: Robert
authors: R
authors: Canby
authors: Monia
authors: M
authors: Minati
authors: Larry D
authors: LD
authors: Price
authors: C Lynn
authors: CL
authors: Hutchins
authors: Melody A
authors: MA
authors: Muir
authors: Leonardo
authors: L
authors: Calo'
authors: Andrea
authors: A
authors: Natale
authors: Gery F
authors: GF
authors: Tomassoni
mesh_terms: D000368:Aged; D002037:Bundle-Branch Block / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D004452:Echocardiography / Q000295:instrumentation / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D014672:Vectorcardiography / Q000295:instrumentation* / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy