Procedural coronary sinus lead location assessment and comparison with actual adjudicated location

Background:

Speckle tracking radial strain imaging (STRSI)-based targeting of LV lead placement has recently been suggested as a tool to improve response to cardiac resynchronization therapy (CRT). RAISE-CRT study was designed to evaluate the CRT response rate with coronary sinus (CS) lead placement according to STRSI versus traditional CS lead placement. We sought to evaluate the location placement assessed be the operator with the actual assessment as found by the study`s adjudication committee. Correct translation of the echo-defined best segment into location to fluoroscopy during the procedure is required in order to achieve favorable results.

Methods:

RAISE-CRT enrolled 172 patients, and after excluding deaths before implantation unsuccessful CRT placement procedure and consent withdrawal 144 patient`s data (99 treatment; 45 controls) was available with operator assessment following the procedure and the final position adjudication defined by 9 segments of the LV.

Results:

A match between position by the operator`s assessment and position by adjudication was found in 101 patients (70.1%) with no difference between the treatment arm (69/99; 69.7%) and controls (32/45; 71.1%). Agreement was highest regarding posterior location of the CS lead (85.3%) followed by lateral position (80.8%). Anterior lead location as assessed by the operator, was verified to be correct only in 42.3% of the cases (11/26).

Conclusion:

CS lead placement as assessed by the operator during CRT implant procedure was accurate in only 7 out of 10 cases. Imaging guided CS lead implantation to a specific location will require better laboratory tools in order to ensure lead position at a pre-defined target.