An exploratory study on coronary sinus lead tip three-dimensional trajectory changes in cardiac resynchronization...

Area of Science:

• Cardiology
• Biomedical Engineering
• Medical Imaging

Background:

• Predicting response to cardiac resynchronization therapy (CRT) remains a challenge.
• The relationship between left ventricular mechanics and coronary sinus (CS) lead behavior during pacing is underexplored.

Purpose of the Study:

• To investigate CS lead tip movements during biventricular pacing (BiV).
• To determine if these movements offer insights into left ventricular mechanical behavior and CRT response.

Main Methods:

• Utilized a novel fluoroscopy-based method for 3D reconstruction of CS lead tip trajectory.
• Analyzed trajectories at baseline (T-1), immediately after BiV start-up (T0), and after 6 months (T1) in 22 heart failure patients.
• Compared trajectory metrics between CRT responders and non-responders.

Main Results:

• At BiV start-up (T0), responders showed a statistically significant change towards a more circular CS lead tip trajectory compared to non-responders.
• The percent variation in the S1/S2 ratio from T-1 to T0 effectively distinguished between responders and non-responders.
• This single marker at T0 predicted CRT response at 6 months.

Conclusions:

• Changes in CS lead tip trajectory induced by BiV pacing are linked to mechanical resynchronization.
• CS lead tip movement analysis shows promise as a predictor of CRT efficacy.