心室再同步化治疗左室电极位置选择

1、30-40% of the patients do not respond to CRT with improved clinical symptoms and cardiac function.The location of the LV lead is one of the most important causes of CRT non-response.The optimal LV lead position should pace the site of latest activation and avoid scar. Lack of the information about m

2、yocardial scarLack of the information about late contractionDifficulty to correspond venous anatomy with myocardial regions Cardiac ECT to assess myocardial scarCardiac ECT to assess site of latest activation3D fusion of ECT myocardial image and venous anatomy on fluoroscopy venogram Cardiac ECT ima

3、ging is available in nuclear medicine departments in all class IIIA hospitals in China.With radioactive tracers, the left-ventricular myocardium can be imaged using ECT.Tian et al. J Nucl Med 2012;53:894-901Tian et al. J Nucl Med 2012;53:894-901AHA17-SegmentModel1281281281281 2 3 4 5 6 7 8 1 2 3 4 5

4、Gate:Chen et al, J Nucl Cardiol 2005;12:687-95Cardiac ECT can assess myocardial scar on the left ventricle. Scar regions have significantly lower tracer uptake than normal regions.Cardiac ECT can assess LV function. Specifically, with the phase analysis technique, cardiac ECT can assess LV dyssynchr

5、ony and identify regions with late mechanical activation.Scar regions are usually associated with late activation. To identify the optimal position for CRT LV lead placement needs to integrate both assessments of myocardial scar and late activation.ECT-guided LV lead placement leads to CRT response0

6、1006 WCH: Guiding the LV lead to the region with late activation10001 JSY: Guiding the LV lead to avoid scarLAO 45 ViewRAO 30 ViewLAO 45 ViewRAO 30 ViewBaselineBaselineBaselineFollow-upFollow-upFollow-upBaselineFollow-upBaselineBaselineBaselineFollow-upFollow-upFollow-upBaselineFollow-upA prospectiv

7、e, randomized, multi-center trial to validate the clinical value of ECT-guided LV lead placement for incremental benefits to CRT efficacy23 participating medical centers in ChinaNanjing Medical UniversityPrimary Endpoint:Reduction of LVESV 15% at 6-month follow-up, assessed by echocardiographySecond

8、ary Endpoints:Reduction of LVEDV 15% at 6-month follow-up, assessed by echocardiographyIncrease of LVEF 5% at 6-month follow-up, assessed by echocardiographyComposite clinical endpoint (improvement in NYHA class, QOL score, and 6MWD)3D Fusion of venous anatomy and myocardial region is critical to the success of ECT-guided LV lead placement.CT venogram in fusion with ECT image can be used for pre-implant assessment. The disadvantage of this approach is that an additional CT scan is added to the patient, increasing the cost and radiation burden.Int