Delivery of CRT guided by non-invasive anatomy assessment

Results from the first 9 participants of the CRT-DRIVE study suggest that the efficacy of cardiac resynchronisation therapy (CRT) can be increased by applying a cloud-based, pre-procedural, multimodality ‘CRT roadmap’. The system was highly accurate in coronary sinus vein anatomy assessment and 3D ventricular electrical activation, which allowed interventions to be more precise.

The CRT-DRIVE study (NCT05327062) is a controlled, multicentre study investigating the feasibility of pre-interventional guidance of CRT by non-invasive electrical and venous anatomy assessment, to allow for patient-tailored implantation [1]. The system integrates 3D images of a 3D activation sequence from an electrocardiogram and the coronary venous anatomy from cardiac computerised tomography. The resulting CRT roadmap guides left ventricular (LV) lead placement to a coronary vein in an electrically late-activated region.

“Our system enhances the precision of the interventions,” said Dr Mikhail Chmelevsky (Cardiocentro Ticino Institute, Switzerland). “It is a unique workflow that integrates seamlessly into existing clinical processes without disruption.” He stressed the importance of the system's fast data-processing capabilities, which ensure that results and images are available at the time of implantation, thus informing decision-making. The 3D visualisation of ventricular electrical activation during CRT programming improves the quality of the procedure, observed Dr Chmelevsky, but it also gives a unique opportunity for effective follow-up.

CRT-DRIVE aims to include 150 participants, said Dr Chmelevsky; thus far, 25 participants have been included, and the results of the first 9 were presented. After 6 months, the results of 9 participants showed that non-invasive mapping was associated with a significant reduction in LV end-systolic volume and a significant increase in LV ejection fraction (P=0.008 for both).

Dr Chmelevsky added that many aspects still require further clarification, such as the procedure's reliability, reproducibility, accessibility, and affordability, as well as the strength of the efficacy endpoints used. Further larger scale studies are needed to assess the efficacy of the non-invasive mapping system.

1. 
   
   1. Chmelevsky M, et al. Cardiac resynchronization therapy delivery guided by non-invasive electrical and venous anatomy assessment (CRT-DRIVE) clinical trial. Late breaking clinical trials: devices, Heart Failure 2024, 11–14 May, Lisbon, Portugal.

Copyright ©2024 Medicom Medical Publishers



Posted on 16 July 202416 July 2024