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3D dynamic position assessment of the coronary sinus lead in cardiac resynchronization therapy
Cristiana Corsi1, Corrado Tomasi, Dario Turco
1Department of Electronics, Computer Science and Systems, University of Bologna, Cesena, Italy. cristiana.corsi3@unibo.it
Insights
A new 3D method accurately tracks coronary sinus (CS) lead movement during cardiac resynchronization therapy (CRT). This technique may improve CRT outcomes by understanding lead dynamics and patient response.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Imaging
Background:
- Cardiac resynchronization therapy (CRT) improves heart failure outcomes but has suboptimal response rates in about one-third of patients.
- Effective CRT relies on optimal pacing lead interaction within coronary sinus (CS) branches.
- Lead migration, even minor, can impact CRT mechanics, yet its 3D dynamics remain understudied using 2D methods.
Purpose of the Study:
- To develop and validate a novel 3D method for quantifying CS lead position throughout the cardiac cycle.
- To assess the accuracy and reproducibility of this 3D method for tracking lead dynamics.
- To compare CS lead positions at implant versus follow-up using chest fluoroscopy.
Main Methods:
- Development of a 3D quantification technique for CS lead position using chest fluoroscopy.
- Assessment of method performance, including accuracy (0.3 ± 0.1 mm) and resolution (0.5 mm).
- Calculation of intra- and inter-observer discordance for lead trajectories (2.2 ± 1.5 mm and 5.5 ± 3.6 mm, respectively).
Main Results:
- The developed 3D method accurately quantifies dynamic CS lead placement in three dimensions.
- The method demonstrated high accuracy and reproducibility in assessing lead position.
- Significant intra- and inter-observer agreement was achieved, indicating reliability.
Conclusions:
- The novel 3D method provides accurate and reproducible measurements of dynamic CS lead placement.
- Investigating the 3D dynamics of CS leads offers potential for deeper insights into CRT mechanics.
- This technique may help optimize CRT lead positioning and improve patient response.
Abstract:
Although cardiac resynchronization therapy (CRT) is an effective treatment for chronic systolic heart failure with dyssynchrony, about one-third of patients do not respond favorably. The interaction between the pacing lead and the coronary sinus (CS) branches is of paramount importance for an effective resynchronization. Minor changes in lead position overtime could interfere with CRT mechanics, without affecting even biophysical parameters or ECG morphology. Although late post-implant CS lead dislodgement rate is consistent, lead movements have been little investigated and only with bi-dimensional methods. The aim of this study was (1) to develop a method for quantifying CS lead position in the 3D domain throughout the cardiac cycle and (2) to test it by comparing the CS lead position at implant and at follow-up, using chest fluoroscopy. Method performance, its accuracy and reproducibility were qualitatively and quantitatively assessed. Intra- and inter-observer percent discordance between trajectories were also computed. The accuracy of the procedure resulted in 0.3 ± 0.1 mm and its resolution was 0.5 mm. Intra- and inter-observer discordances were 2.2 ± 1.5 and 5.5 ± 3.6 mm, respectively. The proposed method for measuring the CS lead dynamic placement in 3D space seems accurate and reproducible. Investigating CS lead 3D dynamics could provide further insights into CRT mechanics.
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