Optimizing CRT Lead Placement Accuracy With CMR-Guided On-Screen Targeting: A Randomized Controlled Trial (ADVISE-CRT III).

IF 8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Willem Gerrits, Philippe C Wouters, Cheyenne S L Chiu, Marco Guglielmo, Maarten J Cramer, Pim van der Harst, Kevin Vernooy, Antonius M W van Stipdonk, Vokko P van Halm, Vincent F van Dijk, Abdul Ghani, Alexander H Maass, Sing-Cien Yap, Frebus J van Slochteren, Mathias Meine
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引用次数: 0

Abstract

Background: To improve cardiac resynchronization therapy (CRT) an on-screen image-guidance platform, CARTBox-Suite (CART-Tech B.V.), was developed to identify left ventricular pacing electrode (LVPE) implantation sites and facilitate precise LVPE placement. This multicenter randomized trial evaluated the efficacy of image guidance on LVPE implantation accuracy and its impact on left ventricular end-systolic volume (LVESV) reduction 6 months after CRT.

Objectives: The aim of this trial is to improve the accuracy and efficacy of LVPE placement in CRT.

Methods: A total of 131 heart failure patients (80% with Class I CRT indication) were enrolled across 7 hospitals in the Netherlands. CARTBox-Suite, which utilizes a cloud-based AI algorithm, was used to identify a target area with late mechanical activation based on cardiac magnetic resonance imaging. Scarred areas marked by late gadolinium enhancement were excluded. Patients were randomized to image-guided implantation, with on-screen guidance during the procedure or conventional implantation.

Results: The primary endpoint, LVPE implantation in the target area, was achieved significantly more often in the image-guided group (66.7% vs 29.2%; P < 0.001). The secondary endpoint was fewer LVPE placed in scarred areas in the image-guided group (7.1% vs 36.4%; P = 0.006). Mean LVESV reduction was greater in the image-guided group (43.2% vs. 37.6%), although not significantly (P = 0.166). Patients with myocardial scar showed greater LVESV reduction with image guidance (40.7% vs 27.7%; P = 0.028).

Conclusions: Image-guided implantation resulted in significantly more LVPE placed in the target area and greater LVESV reduction in patients with myocardial scar.

优化CRT导联放置精度与cmr引导屏幕上的目标:一项随机对照试验(建议-CRT III)。
背景:为了改善心脏再同步化治疗(CRT),开发了一种屏幕图像引导平台CARTBox-Suite (CART-Tech B.V.),用于识别左心室起搏电极(LVPE)的植入位置并促进LVPE的精确放置。本多中心随机试验评估了图像引导对LVPE植入准确性的影响及其对CRT后6个月左室收缩末期容积(LVESV)减少的影响。目的:本试验的目的是提高在CRT中LVPE放置的准确性和有效性。方法:来自荷兰7家医院的131例心力衰竭患者(80%为I类CRT指征)被纳入研究。carbox - suite利用基于云的人工智能算法,根据心脏磁共振成像识别机械激活晚期的目标区域。排除晚期钆强化标记的瘢痕区域。患者被随机分配到图像引导植入,在手术过程中有屏幕引导或常规植入。结果:图像引导组的主要终点LVPE在靶区植入术成功率更高(66.7% vs 29.2%;P < 0.001)。次要终点是图像引导组瘢痕区LVPE放置较少(7.1% vs 36.4%;P = 0.006)。图像引导组平均LVESV降低幅度更大(43.2%比37.6%),但差异不显著(P = 0.166)。心肌瘢痕患者在图像引导下LVESV降低幅度更大(40.7% vs 27.7%;P = 0.028)。结论:图像引导下心肌瘢痕患者靶区LVPE放置量明显增加,LVESV降低幅度较大。
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来源期刊
JACC. Clinical electrophysiology
JACC. Clinical electrophysiology CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
10.30
自引率
5.70%
发文量
250
期刊介绍: JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.
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