Real-time CT-guided percutaneous placement of LV pacing leads.
Academic Article
Overview
abstract
OBJECTIVES: The aim of this study was to assess the feasibility of real-time computed tomographic (CT) imaging to guide the percutaneous placement of left ventricular (LV) leads in an animal model. BACKGROUND: Cardiac resynchronization therapy has been shown to improve morbidity and mortality in patients with chronic heart failure. However, placement of the coronary sinus lead can be challenging and may require a more aggressive surgical approach. METHODS: Nine swine were placed in a real-time CT scanner to define the safest percutaneous access strategy. Under real-time CT guidance, a 3.5-F pacing lead was placed percutaneously in the anterolateral LV epicardium (n = 6 swine) or to the posterolateral wall after the creation of intentional left pneumothorax (n = 3 swine) in a tangential (n = 12) or perpendicular (n = 1) approach. Pacing parameters and CT images were assessed during 30-min follow-up. Necropsy findings were compared with real-time CT images. RESULTS: CT imaging successfully defined the safest percutaneous access route in all 13 lead placements and guided the therapeutic creation of pneumothoraces. Needle trajectory remained within 5 mm of the access route defined on CT imaging. LV lead placement under CT guidance was successful in all attempts within 19 ± 7 min. The mean pacing thresholds was 2.5 ± 1.5 V, the mean R wave amplitude was 11.2 ± 5.6 mV, and the mean impedance was 686 ± 103 Ω and remained unchanged after tangential placement during 30-min follow-up. Although no cardiac complications were observed with tangential lead placement (12 of 12), the perpendicular approach resulted in a pericardial effusion requiring pericardiocentesis. At necropsy, CT images correlated well with the in situ pathological results. CONCLUSIONS: Percutaneous placement of LV pacing leads under CT guidance is feasible and might offer an alternative to more invasive surgical approaches in patients with complicated coronary sinus lead placement.
