Optimization of Coronary Sinus Lead Position in Cardiac Resynchronization Therapy guided by Three Dimensional Echocardiography

Abstract

Heart failure is a complex clinical syndrome characterized by impaired myocardial performance and progressive activation of neuroendocrine system leading to circulatory insufficiency and congestion. Cardiac resynchronization therapy (CRT) is now an established treatment for patients with advanced heart failure. Apart from clinical benefits, improvement of left ventricular (LV) systolic function and associated LV reverse remodeling have been well reported. Numerous studies have demonstrated the efficacy of CRT in treatment of patients with advanced heart failure. One of the earliest and most common applications of clinical echocardiography is evaluation of left ventricular (LV) function and size. Three-dimensional echo-cardiographic (3DE) techniques showed better reproducibility than two - dimensional (2D) echo-cardiography and narrower limits of agreement for assessment of LV function and size in comparison with reference methods, mostly cardiac magnetic resonance (CMR) imaging. The rate of approximately 30% of inadequate responders remains an unsolved problem. One approach to improve outcome may be determination of the degree of asynchrony before CRT as a predictor for CRT response. Conversely, the focus may be on an improved positioning of the left ventricular (LV) lead. To improve outcome and reduce the proportion of