Combining Myocardial Strain and Cardiac CT to Optimize Left Ventricular Lead Placement in CRT Treatment

Individually Tailored Cardiac Resynchronization Therapy - Combing Myocardial Strain and Cardiac CT to Optimize Left Ventricular Lead Placement in Cardiac Resynchronization Therapy

For patients with advanced heart failure, Cardiac Resynchronization Therapy (CRT) has been a major improvement. The treatment improves symptoms and prolongs life in selected patients with heart failure. However, with the current selection criteria and methods for implanting the pacemaker, only 60-70% of the patients derive significant benefit from the treatment.

New imaging techniques, including advanced ultrasound and computed tomography, in combination with new versatile multi-pole electrodes, have made an individually tailored therapy possible. Using these techniques in combination, the study will investigate the effect of individually based "optimal" placement of the pacemaker electrodes vs. standard care. The optimal LV electrode position is defined as pacing a viable segment with the latest mechanical delay, targeting a specific segment of the coronary sinus as visualised on cardiac CT. The hypothesis is that this will increase the number of positive responders from 65% to 85%.

Inclusion Criteria:

• Symptomatic heart failure (New York Heart Association functional class II - IV) despite stabile optimal medical therapy.
• Wide QRS ≥ 120 milliseconds on standard ECG.
• LV systolic dysfunction (EF ≤ 35%).
• Written informed consent.
• Accepted for CRT-P or CRT-D treatment

Exclusion Criteria:

• Life expectancy < 12 months.
• Recent myocardial infarction (< 3 months).
• Significant valve disease
• Chronic atrial fibrillation
• Pregnancy
• Severely impaired renal function (estimated glomerular filtration rate (eGFR) < 30 ml/min)
• Unable to give written informed consent.