Related Experiment Video
Updated: Jul 8, 2026
Remote Magnetic Navigation for Accurate, Real-time Catheter Positioning and Ablation in Cardiac Electrophysiology Procedures
Published on: April 21, 2013
Conduction-guided intervention: A first-in-human study of computed tomography angiography-guided targeting of
Óscar Cano1, Justin T Tretter2, Tarikh Asyraf3
1Hospital Universitari i Politècnic La Fe, Valencia, Spain; Instituto de Investigación Sanitaria La Fe, Valencia, Spain; Centro de Investigaciones Biomédicas en RED en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Department of Cardiology, Ascires Hospital, Valencia, Spain.
Background:
Conduction system pacing (CSP) remains technically challenging because intentional targeting of proximal conduction structures, such as the distal His bundle and proximal left bundle branch (LBB) trunk, is difficult using current implantation techniques.
Objective:
We evaluated a novel computed tomography angiography (CTA)-guided workflow designed to facilitate patient-specific targeting of these structures.
Methods:
Conduction-guided intervention (CGI) integrates preprocedural cardiac CTA with patient-specific conduction system reconstruction and real-time fluoroscopic overlay. In this first-in-human prospective study, 40 consecutive patients undergoing CSP were enrolled. Procedural success was defined as implantation at a proximal conduction system target according to predefined anatomical and electrophysiological criteria. Clinical success required proximal conduction system capture with QRS correction at working output.
Results:
Procedural success was achieved in 38/40 patients (95%). CTA analysis demonstrated substantial inter-individual variability in proximal conduction system anatomy, with marked differences in distances and trajectories along the AVN-His axis between patients. Distal His pacing according to predefined procedural criteria was initially achieved in 26 patients (65%). However, transition to proximal LBB trunk pacing was required in 12 patients because of inadequate QRS correction and/or unfavorable pacing thresholds. Final adjudicated pacing sites included distal His pacing in 14 patients (35%) and proximal LBB trunk pacing in 22 patients (55%), resulting in proximal conduction system pacing in 36/40 patients (clinical success 90%).
Conclusion:
CTA-guided conduction system mapping was feasible and enabled intentional targeting of proximal conduction structures in most patients. Integration of patient-specific anatomical information may complement conventional fluoroscopic and electrophysiological guidance during CSP implantation.
More Related Videos
09:33Neuronavigated Focalized Transcranial Direct Current Stimulation Administered During Functional Magnetic Resonance Imaging
Published on: November 15, 2024
14:14Targeting Neuronal Fiber Tracts for Deep Brain Stimulation Therapy Using Interactive, Patient-Specific Models
Published on: August 12, 2018