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An image fusion tool for echo-guided left ventricular lead placement in cardiac resynchronization therapy: Performance and workflow integration analysis.

Authors
  • Babić, Aleksandar1, 2, 3
  • Odland, Hans Henrik1, 3, 4
  • Lyseggen, Erik1, 4
  • Holm, Torbjørn4
  • Ross, Stian1, 3, 4
  • Hopp, Einar1, 5
  • Haugaa, Kristina H1, 3, 4
  • Kongsgård, Erik1, 4
  • Edvardsen, Thor1, 3, 4
  • Gérard, Olivier1, 2
  • Samset, Eigil1, 2, 3
  • 1 Center for Cardiological Innovation, Oslo, Norway. , (Norway)
  • 2 GE Vingmed Ultrasound, Horten, Norway. , (Norway)
  • 3 University of Oslo, Oslo, Norway. , (Norway)
  • 4 Department of Cardiology, Oslo University Hospital, Oslo, Norway. , (Norway)
  • 5 Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway. , (Norway)
Type
Published Article
Journal
Echocardiography (Mount Kisco, N.Y.)
Publication Date
Oct 01, 2019
Volume
36
Issue
10
Pages
1834–1845
Identifiers
DOI: 10.1111/echo.14483
PMID: 31628770
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The response rate to cardiac resynchronization therapy (CRT) may be improved if echocardiographic-derived parameters are used to guide the left ventricular (LV) lead deployment. Tools to visually integrate deformation imaging and fluoroscopy to take advantage of the combined information are lacking. An image fusion tool for echo-guided LV lead placement in CRT was developed. A personalized average 3D cardiac model aided visualization of patient-specific LV function in fluoroscopy. A set of coronary venography-derived landmarks facilitated registration of the 3D model with fluoroscopy into a single multimodality image. The fusion was both performed and analyzed retrospectively in 30 cases. Baseline time-to-peak values from echocardiography speckle-tracking radial strain traces were color-coded onto the fused LV. LV segments with suspected scar tissue were excluded by cardiac magnetic resonance imaging. The postoperative augmented image was used to investigate: (a) registration accuracy and (b) agreement between LV pacing lead location, echo-defined target segments, and CRT response. Registration time (264 ± 25 seconds) and accuracy (4.3 ± 2.3 mm) were found clinically acceptable. A good agreement between pacing location and echo-suggested segments was found in 20 (out of 21) CRT responders. Perioperative integration of the proposed workflow was successfully tested in 2 patients. No additional radiation, compared with the existing workflow, was required. The fusion tool facilitates understanding of the spatial relationship between the coronary veins and the LV function and may help targeted LV lead delivery. © 2019 Wiley Periodicals, Inc.

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