Trajectories of coronary sinus pacing cathode to predict cardiac resynchronization therapy outcome: The TRAJECTORIES...

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Predicting patient response to cardiac resynchronization therapy (CRT) remains a clinical challenge.
• Fluoroscopy-based 3D reconstruction of the coronary sinus (CS) lead trajectory (3DTraj) offers a novel imaging approach.
• Evaluating the 3DTraj's potential for optimizing CRT lead placement is crucial.

Purpose of the Study:

• To assess the correlation between left ventricular (LV) reverse remodeling and acute changes in 3DTraj geometry post-biventricular pacing (BiV) initiation.
• To determine if the 3DTraj can serve as an intra-procedural tool for guiding CS lead pacing site selection.
• To evaluate the predictive value of the TRAJ-index for CRT response.

Main Methods:

• 3DTraj of the pacing cathode was reconstructed before (T_-1) and after (T₀) BiV initiation in 6 centers.
• The TRAJ-index was calculated as the percentage change in 3DTraj main axes ratios between T_-1 and T₀.
• TRAJ-index was correlated with LV end-systolic volume reduction at follow-up; receiver-operator analysis determined the optimal threshold.

Main Results:

• The TRAJ-index demonstrated 77% overall accuracy (AUC=0.86) in predicting CRT response.
• It achieved 88% sensitivity for positive response and 66% for negative response.
• Prediction accuracy was reduced in patients with large LV volumes and significant mitral regurgitation.

Conclusions:

• The TRAJ-index shows promise as an intra-operative tool to guide CS pacing site selection during CRT implantation.
• This method may improve CRT procedural outcomes without requiring additional specialized equipment.
• Further validation is warranted to refine its application in specific patient subgroups.