title: Left and right ventricular lead positions are imprecisely determined by fluoroscopy in cardiac resynchronization therapy: a comparison with cardiac computed tomography.
abstract: OBJECTIVE
  Fluoroscopy is the routine method for localizing left ventricular (LV) and right ventricular (RV) lead positions in cardiac resynchronization therapy (CRT). However, the ability of fluoroscopy to determine lead positions in a standard ventricular segmentation is unknown. We aimed to evaluate the accuracy and reproducibility of fluoroscopy to determine LV and RV lead positions in CRT when compared with cardiac computed tomography (CT).
  
  
  RESULTS
  Fifty-nine patients undergoing CRT were included. Bi-plane fluoroscopy and cardiac CT were evaluated in all patients. Pacing lead positions were assessed in a standard LV 16-segment model and in a simplistic RV 8-segment model. Four patients with LV lead displacement were excluded from the agreement analysis of LV lead position. Agreement of LV lead position between fluoroscopy and cardiac CT was observed in 19 (35%) patients with fluoroscopy demonstrating a 1-segment and ≥2-segment error in 30 (55%) and 6 (11%) patients, respectively. Agreement of RV lead position was found in 13 (22%) patients with fluoroscopy showing a 1-segment and ≥ 2-segment error in 28 (47%) and 18 (31%) patients, respectively. The interobserver agreement on LV and RV lead positions was poor for fluoroscopy (kappa 0.20 and 0.23, respectively) and excellent for cardiac CT (kappa 0.87 and 0.85, respectively).
  
  
  CONCLUSIONS
  Fluoroscopy is inaccurate and modestly reproducible when assessing LV and RV lead positions in a standard ventricular segmentation when compared with cardiac CT. Cardiac CT should be applied to determine the exact pacing site in future research evaluating the optimal pacing lead position in CRT.
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus N DK-8200, Denmark a.sommer@dadlnet.dk.
authors.forename: Anders
authors.initials: A
authors.lastname: Sommer
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus N DK-8200, Denmark.
authors.forename: Mads Brix
authors.initials: MB
authors.lastname: Kronborg
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus N DK-8200, Denmark.
authors.forename: Bjarne Linde
authors.initials: BL
authors.lastname: Nørgaard
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus N DK-8200, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Gerdes
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus N DK-8200, Denmark.
authors.forename: Peter Thomas
authors.initials: PT
authors.lastname: Mortensen
authors.affiliation: Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgaardsvej 100, Aarhus N DK-8200, Denmark.
authors.forename: Jens Cosedis
authors.initials: JC
authors.lastname: Nielsen
mesh_terms: D000368:Aged; D058409:Cardiac Resynchronization Therapy Devices; D004567:Electrodes, Implanted; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006333:Heart Failure / Q000175:diagnosis / Q000517:prevention & control*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D019919:Prosthesis Implantation / Q000379:methods; D015641:Radiography, Interventional / Q000379:methods*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome
keywords: Cardiac computed tomography; Cardiac resynchronization therapy; Fluoroscopy; Left ventricular lead position; Right ventricular lead position