MRI-based software to plan the position of the left ventricular pacing lead during cardiac resynchronization therapy (CRT).
- No software/methodology is available to plan the optimal position of the pacing lead.
- Software would be combined with MRI scan conducted prior to CRT.
- Software would include registered images of ventricle contraction timing, myocardial scar distribution, and coronary vein anatomy.
CRT is invasive, is costly, has significant associated risks, and requires lifelong dependency on a pacing device; however one out of three patients undergoing CRT will not positively respond to treatment. Patients may be responding poorly to CRT due to either poor selection criteria or non-optimal implementation of the bi-ventricular pacing device. A significant amount of work has been done to improve selection of CRT candidates with imaging; however little has been done to optimize the selection of lead positions. In the implementation of CRT, the position of the left ventricular pacing lead has a significant role in patient response, specifically if the lead is placed at the location of latest contraction, then patient response is improved. Currently, there is no methodology or software to aid in planning the left ventricular lead position.
To achieve the highest physiological and mechanical efficiency and maximize the benefit of CRT, the left ventricular pacing lead should be placed at the location of the most delayed contraction that is not predominately scar tissue. Retrospective studies have shown that if the left ventricular lead is located at the “most dyssynchronous” area of the ventricle or region that contracted most recently, then response rates are improved. Unfortunately, preoperative imaging does not provide information about coronary venous anatomy and scar tissue with respect to the area of latest delayed contraction. Dr. Oshinski and his colleagues are developing software that will include and combine registered images of left ventricle contraction timing, myocardial scar distribution, and coronary vein anatomy would provide the information necessary to plan the optimal location of lead placement prior to the CRT procedure that is not in an area of significant scarring. This software, when combined with a pre-CRT MRI scan, will improve lead placement and ultimately patients’ response to CRT.
Software is in development.