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Advanced image fusion to overlay coronary sinus anatomy with real-time fluoroscopy to facilitate left ventricular lead implantation in CRT

Ginks, Matthew R.; Duckett, Simon G.; Knowles, Benjamin R.; Ma, Yingliang; Shetty, Anoop; Bostock, Julian; Cooklin, Michael; Gill, Jas S.; Carr-White, Gerry S.; Razavi, Reza; Schaeffter, Tobias; Rhode, Kawal S.; Rinaldi, C. Aldo

Authors

Matthew R. Ginks

Simon G. Duckett

Benjamin R. Knowles

Anoop Shetty

Julian Bostock

Michael Cooklin

Jas S. Gill

Gerry S. Carr-White

Reza Razavi

Tobias Schaeffter

Kawal S. Rhode

C. Aldo Rinaldi



Abstract

Background: Failure rate for left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) is up to 12%. The use of segmentation tools, advanced image registration software, and high-fidelity images from computerized tomography (CT) and cardiac magnetic resonance (CMR) of the coronary sinus (CS) can guide LV lead implantation. We evaluated the feasibility of advanced image registration onto live fluoroscopic images to allow successful LV lead placement. Methods: Twelve patients (11 male, 59 ± 16.8 years) undergoing CRT had three-dimensional (3D) whole-heart imaging (six CT, six CMR). Eight patients had at least one previously failed LV lead implant. Using segmentation software, anatomical models of the cardiac chambers, CS, and its branches were overlaid onto the live fluoroscopy using a prototype version of the Philips EP Navigator software to guide lead implantation. Results: We achieved high-fidelity segmentations of cardiac chambers, coronary vein anatomy, and accurate registration between the 3D anatomical models and the live fluoroscopy in all 12 patients confirmed by balloon occlusion angiography. The CS was cannulated successfully in every patient and in 11, an LV lead was implanted successfully. (One patient had no acceptable lead values due to extensive myocardial scar.) Conclusion: Using overlaid 3D segmentations of the CS and cardiac chambers, it is feasible to guide CRT implantation in real time by fusing advanced imaging and fluoroscopy. This enabled successful CRT in a group of patients with previously failed implants. This technology has the potential to facilitate CRT and improve implant success. © 2010 Wiley Periodicals, Inc.

Citation

Ginks, M. R., Duckett, S. G., Knowles, B. R., Ma, Y., Shetty, A., Bostock, J., …Rinaldi, C. A. (2011). Advanced image fusion to overlay coronary sinus anatomy with real-time fluoroscopy to facilitate left ventricular lead implantation in CRT. Pacing and Clinical Electrophysiology, 34(2), 226-234. https://doi.org/10.1111/j.1540-8159.2010.02940.x

Journal Article Type Article
Publication Date Feb 1, 2011
Journal PACE - Pacing and Clinical Electrophysiology
Print ISSN 0147-8389
Electronic ISSN 1540-8159
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 34
Issue 2
Pages 226-234
DOI https://doi.org/10.1111/j.1540-8159.2010.02940.x
Keywords cardiac resynchronization therapy, cardiac magnetic resonance imaging, cardiac computer tomography, coronary sinus, congestive heart failure
Public URL https://uwe-repository.worktribe.com/output/965496
Publisher URL http://dx.doi.org/10.1111/j.1540-8159.2010.02940.x