Utility of echocardiographic tissue synchronization imaging to redirect left ventricular lead placement for improved cardiac resynchronization therapy

Kaoru Dohi, Matthew Suffoletto, Leonard Ganz, Marco Zenati, John Gorcsan

Research output: Contribution to journalArticlepeer-review

Abstract

An 80-year-old woman with severe symptomatic heart failure (ejection fraction of 13%), and left bundle branch block (QRS duration of 160 ms) underwent cardiac resynchronization therapy (CRT). She had significant baseline dyssynchrony with a septal to posterior wall delay of 160 ms by echocardiographic tissue synchronization imaging (TSI). Despite exhaustive efforts, a stable posterior-lateral coronary vein lead position could not be achieved with the standard percutaneous approach, resulting in anterior coronary vein lead placement. This resulted in no improvement in the patient's symptoms or ventricular function. Follow-up TSI revealed earlier activation of the anteroseptal site and worsened dyssynchrony with septal to posterior wall delay of now 290 ms. This information prompted surgical revision of the left ventricular (LV) lead position via limited thoracotomy and posterior-lateral epicardial lead implantation. Pacing at the new lead site resulted in a 30% increase in stroke volume and symptomatic improvement. TSI in this case redirected lead position in a clinical nonresponder, resulting in a favorable response to CRT.

Original languageEnglish (US)
Pages (from-to)461-465
Number of pages5
JournalPACE - Pacing and Clinical Electrophysiology
Volume28
Issue number5
DOIs
StatePublished - May 2005

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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