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Europace Advance Access originally published online on June 27, 2008
Europace 2008 10(9):1042-1047; doi:10.1093/europace/eun173
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions©oxfordjournals.org.

Cardiac Resynchronization Therapy

Magnetically guided left ventricular lead implantation based on a virtual three-dimensional reconstructed image of the coronary sinus

Máximo Rivero-Ayerza*, Emil Jessurun, Steve Ramcharitar, Yves van Belle, Patrick W. Serruys and Luc Jordaens

Department of Clinical Electrophysiology, Thoraxcenter, Erasmus MC, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands

Aims: Left ventricular (LV) lead implantation is feasible using remote magnetic navigation of a guidewire (Stereotaxis, St Louis, MO, USA). A novel software that performs a three-dimensional (3D) reconstruction of vessels based on two or more angiographic views has been developed recently (CardiOp-B systemTM, Paeion Inc., Haifa, Israel). The objective of this paper is to evaluate: (i) the performance of the 3D reconstruction software which reproduce the anatomy of the coronary sinus (CS) and (ii) the efficacy of remotely navigating a magnetic guidewire within the CS based on this reconstruction.

Methods and results: In patients undergoing cardiac resynchronization therapy implantation, a 3D reconstruction of the CS was performed using the CardiOp-BTM system. Accuracy of the reconstruction was evaluated by comparing with the CS angiogram. This reconstruction was imported into the Stereotaxis system. On the basis of the reconstruction, magnetic vectors were automatically selected to navigate within the CS and manually adjusted if required. Feasibility of deploying the guidewire and LV lead into the selected side branch (SB), fluoroscopy time (FT) required for cannulation of the target SB, and total FT were also evaluated. Sixteen patients were included. In one case, the software could not reconstruct the CS. The quality of the reconstruction was graded as good in 13 and poor in 2. In 10 cases, manual adjustments to the traced edges of the CS were required to perform the 3D reconstruction, and in 5, no adjustments were required. In 13 patients, the target SB was engaged on the basis of the automatically selected vectors. In two cases, manual modification of the vector was required. Mean total FT was 23 ± 14 min and the FT required to cannulate the target SB was 1.7 ± 1.3 min.

Conclusion: A 3D reconstruction of the CS can be accurately performed using two angiographic views. This reconstruction allows precise magnetic navigation of a guidewire within the CS.

Key Words: Magnetic navigation, Cardiac resynchronization therapy, Three-dimensional reconstruction, Left ventricular lead, Implantation

* Corresponding author. Tel: +31 10 463 2699; fax: +31 10 463 2701.E-mail address: m.riveroayerza{at}erasmusmc.nl

Manuscript submitted 24 February 2008. Accepted after revision 2 June 2008.


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