A Planning and Guidance Platform for Cardiac Resynchronization Therapy

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Drug-refractory heart failure affects many patients, with cardiac resynchronization therapy (CRT) offering a potential treatment.
• However, 30-50% of patients do not respond to CRT, often due to suboptimal left ventricular (LV) lead placement.
• Improved LV lead placement, avoiding scar tissue and targeting latest mechanical activation, can enhance CRT response.

Purpose of the Study:

• To present a comprehensive, automated system for planning and guiding CRT procedures.
• To utilize scar and mechanical activation data for precise LV lead placement.
• To improve patient response rates to CRT.

Main Methods:

• Leveraging standard clinical preoperative magnetic resonance imaging (MRI) for scar and mechanical activation data.
• Registering imaging data to a 3-D coordinate system and visualizing in novel 2-D/3-D American Heart Association plots.
• Overlaying planning information onto live fluoroscopic images for intra-procedural guidance.

Main Results:

• The system successfully guided 14 CRT procedures.
• Validation performed on diverse datasets including synthetic, phantom, volunteer, and patient data.
• Demonstrated feasibility of using scar and mechanical activation for CRT planning.

Conclusions:

• The developed automated system effectively uses scar and mechanical activation imaging for CRT planning and guidance.
• This approach has the potential to improve LV lead placement and increase patient response to CRT.
• Further clinical implementation is warranted to confirm improved outcomes in a larger patient cohort.