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Journal Scan

Left ventricular lead placement in the latest activated region guided by coronary venous electroanatomicmapping.

Europace. 2015 Jan;17(1):84-93.

Left ventricular lead placement in the latest activated region guided by coronary venous electroanatomicmapping.

Rad MM1Blaauw Y2Dinh T2Pison L2Crijns HJ2Prinzen FW3Vernooy K2.


Left ventricular (LV) lead placement in the latest activated region is an important determinant of response to cardiac resynchronization therapy (CRT). We investigated the feasibility of coronary venous electroanatomic mapping (EAM) to guide LV lead placement to the latest activated region.


Twenty-five consecutive CRT candidates with left bundle-branch block underwent intra-procedural coronary venousEAM using EnSite NavX. A guidewire was used to map the coronary veins during intrinsic activation, and to test for phrenic nerve stimulation (PNS). The latest activated region, defined as the region with an electrical delay >75% of total QRS duration, was located anterolaterally in 18 (basal, n = 10; mid, n = 8) and inferolaterally in 6 (basal, n = 3; mid, n = 3). In one patient, identification of the latest activated region was impeded by limitedcoronary venous anatomy. In patients with >1 target vein (n = 12), the anatomically targeted inferolateral vein was rarely the vein with maximal electrical delay (n = 3). A concordant LV lead position was achieved in 18 of 25 patients. In six patients, this was hampered by PNS (n = 4), leadinstability (n = 1), and coronary vein stenosis (n = 1).


Coronary venous EAM can be used intraprocedurally to guide LV lead placement to the latest activated region free of PNS. This approach especially contributes to optimization of LV lead electrical delay in patients with multiple target veins. Conventional anatomical LV leadplacement strategy does not target the vein with maximal electrical delay in many of these patients.



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