Cardiac resynchronization therapy is an effective and widely accessible treatment for patients with advanced, drug-refractory heart failure. It has been shown to reverse maladaptive ventricular remodeling, increase exercise capacity, and lower hospitalization and mortality rates. However, there still exists a considerable proportion of patients who do not respond favorably to the therapy. Tailored left ventricular (LV) lead positioning instead of empiric implantation is thought to have the greatest potential to increase response rates. In our paper, we focus on the rationale for guided LV lead implantation and provide a review of the non-invasive imaging modalities applicable for navigation during LV lead implantation, with special attention to the latest achievements in the field of multimodality imaging and image fusion techniques. Current limitations and future perspectives of the concept are discussed as well.

• Klíčová slova
• Cardiac resynchronization, Coronary sinus, Guided implantation, Image fusion, Mechanical activation, Multimodality imaging, Myocardial scar, Non-responder,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

BACKGROUND: The left ventricular (LV) lead local electrogram (EGM) delay from the beginning of the QRS complex (QLV) is considered a strong predictor of response to cardiac resynchronization therapy. We have developed a method for fast epicardial QLV mapping during video-thoracoscopic surgery to guide LV lead placement. METHODS: A three-port, video-thoracoscopic approach was used for LV free wall epicardial mapping and lead implantation. A decapolar electrophysiological catheter was introduced through one port and systematically attached to multiple accessible LV sites. The pacing lead was targeted to the site with maximum QLV. The LV free wall activation pattern was analyzed in 16 pre-specified anatomical segments. RESULTS: We implanted LV leads in 13 patients with LBBB or IVCD. The procedural and mapping times were 142 ± 39 minutes and 20 ± 9 minutes, respectively. A total of 15.0 ± 2.2 LV segments were mappable with variable spatial distribution of QLV-optimum. The QLV ratio (QLV/QRSd) at the optimum segment was significantly higher (by 0.17 ± 0.08, p < 0.00001) as compared to an empirical midventricular lateral segment. The LV lead was implanted at the optimum segment in 11 patients (at an adjacent segment in 2 patients) achieving a QLV ratio of 0.82 ± 0.09 (range 0.63-0.93) and 99.5 ± 0.6% match with intraprocedural mapping. CONCLUSION: Video-thoracoscopic LV lead implantation can be effectively and safely guided by epicardial QLV mapping. This strategy was highly successful in targeting the selected LV segment and resulted in significantly higher QLV ratios compared to an empirical midventricular lateral segment.

• Klíčová slova
• cardiac resynchronization therapy, epicardial mapping, heart failure, implantable cardioverter defibrillator, left ventricular lead, thoracoscopic implantation, video,
• MeSH
• blokáda Tawarova raménka diagnóza   patofyziologie   terapie   MeSH
• časové faktory MeSH
• design vybavení MeSH
• epikardiální mapování * MeSH
• funkce levé komory srdeční MeSH
• hrudní chirurgie video-asistovaná * MeSH
• komorový tlak (srdce) MeSH
• lidé středního věku MeSH
• lidé MeSH
• perikard patofyziologie   MeSH
• prediktivní hodnota testů MeSH
• prostředky srdeční resynchronizační terapie * MeSH
• senioři MeSH
• srdeční komory patofyziologie   chirurgie   MeSH
• srdeční resynchronizační terapie * škodlivé účinky   MeSH
• studie proveditelnosti MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• hodnotící studie MeSH