Real-time CT-guided percutaneous placement of LV pacing leads Journal Article
| Authors: | Dickfeld, T.; Dauer, L.; Deodhar, A.; Berger, R. D.; Fleiter, T.; Solomon, S. |
| Article Title: | Real-time CT-guided percutaneous placement of LV pacing leads |
| Abstract: | Objectives: The aim of this study was to assess the feasibility of real-time computed tomographic (CT) imaging to guide the percutaneous placement of left ventricular (LV) leads in an animal model. Background: Cardiac resynchronization therapy has been shown to improve morbidity and mortality in patients with chronic heart failure. However, placement of the coronary sinus lead can be challenging and may require a more aggressive surgical approach. Methods: Nine swine were placed in a real-time CT scanner to define the safest percutaneous access strategy. Under real-time CT guidance, a 3.5-F pacing lead was placed percutaneously in the anterolateral LV epicardium (n = 6 swine) or to the posterolateral wall after the creation of intentional left pneumothorax (n = 3 swine) in a tangential (n = 12) or perpendicular (n = 1) approach. Pacing parameters and CT images were assessed during 30-min follow-up. Necropsy findings were compared with real-time CT images. Results: CT imaging successfully defined the safest percutaneous access route in all 13 lead placements and guided the therapeutic creation of pneumothoraces. Needle trajectory remained within 5 mm of the access route defined on CT imaging. LV lead placement under CT guidance was successful in all attempts within 19 ± 7 min. The mean pacing thresholds was 2.5 ± 1.5 V, the mean R wave amplitude was 11.2 ± 5.6 mV, and the mean impedance was 686 ± 103 Ω and remained unchanged after tangential placement during 30-min follow-up. Although no cardiac complications were observed with tangential lead placement (12 of 12), the perpendicular approach resulted in a pericardial effusion requiring pericardiocentesis. At necropsy, CT images correlated well with the in situ pathological results. Conclusions: Percutaneous placement of LV pacing leads under CT guidance is feasible and might offer an alternative to more invasive surgical approaches in patients with complicated coronary sinus lead placement. © 2013 American College of Cardiology Foundation. |
| Keywords: | computed tomography; left ventricular pacing; percutaneous access; real-time guidance |
| Journal Title: | JACC: Cardiovascular Imaging |
| Volume: | 6 |
| Issue: | 1 |
| ISSN: | 1936-878X |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2013-01-01 |
| Start Page: | 96 |
| End Page: | 104 |
| Language: | English |
| DOI: | 10.1016/j.jcmg.2012.06.012 |
| PROVIDER: | scopus |
| PUBMED: | 23328567 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 1 February 2013" - "Source: Scopus" |
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