Combined preoperative information using a bullseye plot from speckle tracking echocardiography, cardiac CT scan, and MRI scan: targeted left ventricular lead implantation in patients receiving cardiac resynchronization therapy

Aims: To evaluate the feasibility and incremental value of using an integrated bullseye model for presenting data from cardiac computed tomography (CT) and magnetic resonance imaging (MRI) in combination with echocardiography evaluation of segmental mechanical delay for guiding optimal left ventricular lead placement in cardiac resynchronization therapy (CRT).

Methods and results: Thirty-nine patients (69 ± 9.7 years, 77% male, 82% with LBBB, 54% with ischaemic cardiomyopathy, 82% New York Heart Association classification of heart failure III) eligible for CRT were included. The left ventricular segment with the latest mechanical activation was determined by echocardiography with speckle tracking radial strain. Cardiac CT scan was used for anatomical evaluation of the coronary sinus and its branches. Cardiac MRI was used for evaluation of viability. A composite bullseye plot was constructed, indicating the most appropriate site for left ventricle (LV) lead placement. The latest mechanical delay was in the basal-anterior (3%), basal-inferior (3%), basal-inferolateral (13%), basal-anterolateral (21%), mid-anterior (8%), mid-inferior (3%), mid-inferolateral (34%), and mid-anterolateral (16%) segment. There were on average 2.5 ± 0.8 veins of suitable sizes (≥1.5 mm in diameter). A preoperative combined bullseye plot indicated that in 53% of the patients, there was a matching vein in the segment with the latest mechanical delay. If immediately adjacent segments were included, an optimal placement was possible in 95% of the patients. At 6 months, there was a statistically significant reduction in the left ventricular end systolic volume and the left ventricular ejection fraction was improved (P < 0.01).

Conclusion: Presenting data from echocardiography, cardiac CT, and MRI in a combined bullseye plot is both feasible and convenient for indicating the most appropriate site for LV lead placement. An optimal electrode position can be suggested in almost all patients.