Jonathan M Behar1, Peter Mountney2, Daniel Toth3, Sabrina Reiml4, Maria Panayiotou5, Alexander Brost4, Bernhard Fahn4, Rashed Karim5, Simon Claridge5, Tom Jackson5, Ben Sieniewicz5, Nik Patel5, Mark O'Neill5, Reza Razavi5, Kawal Rhode5, Christopher Aldo Rinaldi5. 1. Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom. Electronic address: jonathanbehar@gmail.com. 2. Medical Imaging Technologies, Siemens Healthineers, Princeton, New Jersey. 3. Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom; Siemens Healthineers, Frimley, Camberley, United Kingdom. 4. Siemens Healthcare GmbH, Erlangen, Germany. 5. Department of Imaging Sciences and Biomedical Engineering, King's College London, & Guy's and St Thomas' Hospital, London, United Kingdom.
Abstract
OBJECTIVES: This study sought to test the feasibility of a purpose-built, integrated software platform to process, analyze, and overlay cardiac magnetic resonance (CMR) data in real time within a combined cardiac catheter laboratory and magnetic resonance imaging scanner suite (X-MRI) to guide left ventricular (LV) lead implantation. BACKGROUND: Suboptimal LV lead position is a major determinant of poor cardiac resynchronization therapy (CRT) response, and the optimal site is highly patient specific. Pacing myocardial scar is associated with poorer outcomes; conversely, targeting latest mechanical activation (LMA) may improve them. METHODS: Fourteen patients (age 74 ± 5.1 years; New York Heart Association functional class: 2.7 ± 0.4; 86% ischemic with ejection fraction 27 ± 7.6%; QRSd: 157 ± 19 ms) underwent CMR followed by immediate CRT implantation using derived scar and dyssynchrony data, overlaid onto fluoroscopy in an X-MRI suite. Rapid LV segmentation enabled detailed scar quantification, identification of LMA segments, and selection of myocardial targets. At coronary venography, the CMR-derived 3-dimensional shell was fused, enabling identification of viable venous targets subtended by target segments for LV lead placement. RESULTS: The platform was successful in all 14 patients, of whom 10 (71%) were paced in pre-procedurally defined target segments. Pacing in CMR-defined target segments (out of scar) showed a significant decrease in the LV capture threshold (mean difference: 2.4 [1.5 to 3.2]; p < 0.001) and shorter paced QRS duration (mean difference: 25 [15 to 34]; p < 0.001) compared with pacing in areas of CMR determined scar. In 5 (36%) patients with extensive scar in the posterolateral wall, CMR guidance enabled successful lead delivery in an alternative anatomically favorable site. Radiation dose and implant times were similar to historical controls (p = NS). CONCLUSIONS: Real-time CMR-guided LV lead placement is feasible and achievable in a single clinical setting and may prove helpful to preferentially select sites for LV lead placement.
OBJECTIVES: This study sought to test the feasibility of a purpose-built, integrated software platform to process, analyze, and overlay cardiac magnetic resonance (CMR) data in real time within a combined cardiac catheter laboratory and magnetic resonance imaging scanner suite (X-MRI) to guide left ventricular (LV) lead implantation. BACKGROUND: Suboptimal LV lead position is a major determinant of poor cardiac resynchronization therapy (CRT) response, and the optimal site is highly patient specific. Pacing myocardial scar is associated with poorer outcomes; conversely, targeting latest mechanical activation (LMA) may improve them. METHODS: Fourteen patients (age 74 ± 5.1 years; New York Heart Association functional class: 2.7 ± 0.4; 86% ischemic with ejection fraction 27 ± 7.6%; QRSd: 157 ± 19 ms) underwent CMR followed by immediate CRT implantation using derived scar and dyssynchrony data, overlaid onto fluoroscopy in an X-MRI suite. Rapid LV segmentation enabled detailed scar quantification, identification of LMA segments, and selection of myocardial targets. At coronary venography, the CMR-derived 3-dimensional shell was fused, enabling identification of viable venous targets subtended by target segments for LV lead placement. RESULTS: The platform was successful in all 14 patients, of whom 10 (71%) were paced in pre-procedurally defined target segments. Pacing in CMR-defined target segments (out of scar) showed a significant decrease in the LV capture threshold (mean difference: 2.4 [1.5 to 3.2]; p < 0.001) and shorter paced QRS duration (mean difference: 25 [15 to 34]; p < 0.001) compared with pacing in areas of CMR determined scar. In 5 (36%) patients with extensive scar in the posterolateral wall, CMR guidance enabled successful lead delivery in an alternative anatomically favorable site. Radiation dose and implant times were similar to historical controls (p = NS). CONCLUSIONS: Real-time CMR-guided LV lead placement is feasible and achievable in a single clinical setting and may prove helpful to preferentially select sites for LV lead placement.
Authors: Odette A E Salden; Hans T van den Broek; Wouter M van Everdingen; Firdaus A A Mohamed Hoesein; Birgitta K Velthuis; Pieter A Doevendans; Maarten-Jan Cramer; Anton E Tuinenburg; Paul Leufkens; Frebus J van Slochteren; Mathias Meine Journal: Int J Cardiovasc Imaging Date: 2019-03-07 Impact factor: 2.357
Authors: Baldeep S Sidhu; Justin Gould; Mark K Elliott; Vishal Mehta; Steven Niederer; Christopher A Rinaldi Journal: Arrhythm Electrophysiol Rev Date: 2021-04
Authors: Maria Panayiotou; R James Housden; Athanasius Ishak; Alexander Brost; Christopher A Rinaldi; Benjamin Sieniewicz; Jonathan M Behar; Tanja Kurzendorfer; Kawal S Rhode Journal: Int J Comput Assist Radiol Surg Date: 2018-03-30 Impact factor: 2.924
Authors: Benjamin J Sieniewicz; Justin Gould; Bradley Porter; Baldeep S Sidhu; Jonathan M Behar; Simon Claridge; Steve Niederer; Christopher A Rinaldi Journal: Expert Rev Med Devices Date: 2018-07-30 Impact factor: 3.166
Authors: Rashed Karim; Lauren-Emma Blake; Jiro Inoue; Qian Tao; Shuman Jia; R James Housden; Pranav Bhagirath; Jean-Luc Duval; Marta Varela; Jonathan M Behar; Loïc Cadour; Rob J van der Geest; Hubert Cochet; Maria Drangova; Maxime Sermesant; Reza Razavi; Oleg Aslanidi; Ronak Rajani; Kawal Rhode Journal: Med Image Anal Date: 2018-08-24 Impact factor: 8.545