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Delivery of CRT guided by non-invasive anatomy assessment

Presented by
Dr Mikhail Chmelevsky, Cardiocentro Ticino Institute, Switzerland
HFA 2024
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 (CS) 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 that assesses the feasibility of a patient-tailored implantation, by first integrating 3D images from a 3D activation sequence from an ECG and the coronary venous anatomy obtained from cardiac CT. The resulting CRT-roadmap then guides LV lead placement to a coronary vein in an electrically late-activated region. CRT-DRIVE aims to include 150 patients, said Dr Mikhail Chmelevsky (Cardiocentro Ticino Institute, Switzerland); thus far, 25 patients have been included, and results of the first 9 were presented [1].

“Our system enhances the precision of the interventions,” said Dr Chmelevsky. “It is a unique workflow that integrates seamlessly into existing clinical processes without disruption.” He stressed the importance of fast data processing; this ensures that results and images are available at the time of implantation and can thus inform decision-making. The 3D visualisation of ventricular electrical activation during CRT programming improves the quality of the procedure, observed Dr Chmelevsky, but also gives a unique opportunity for effective follow-up.

Overall, many aspects still require further clarification, such as the procedure's reliability, reproducibility, accessibility, and affordability, as well as the strength of the used efficacy endpoints.

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

Medical writing support was provided by Michiel Tent.
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