Positioning of left ventricular pacing lead guided by intracardiac echocardiography with vector velocity imaging during cardiac resynchronization therapy procedure

Rong Bai, Luigi Di Biase, Prasant Mohanty, Aaron B. Hesselson, Ermenegildo De Ruvo, Peter L. Gallagher, Claude S. Elayi, Sanghamitra Mohanty, Javier E. Sanchez, J. David Burkhardt, Rodney Horton, G. Joseph Gallinghouse, Shane M. Bailey, Jason D. Zagrodzky, Robert Canby, Monia Minati, Larry D. Price, C. Lynn Hutchins, Melody A. Muir, Leonardo Calo'Andrea Natale, Gery F. Tomassoni

Research output: Contribution to journalArticlepeer-review

25 Scopus citations


LV Lead Positioning Guided by ICE With Vector Velocity Imaging. Introduction: Intraoperative modality for "real-time" left ventricular (LV) dyssynchrony quantification and optimal resynchronization is not established. This study determined the feasibility, safety, and efficacy of intracardiac echocardiography (ICE), coupled with vector velocity imaging (VVI), to evaluate LV dyssynchrony and to guide LV lead placement at the time of cardiac resynchronization therapy (CRT) implant. Methods: One hundred and four consecutive heart failure patients undergoing ICE-guided (Group 1, N = 50) or conventional (Group 2, N = 54) CRT implant were included in the study. For Group 1 patients, LV dyssynchrony and resynchronization were evaluated by VVI including visual algorithms and the maximum differences in time-to-peak (MD-TTP) radial strain. Based on the findings, the final LV lead site was determined and optimal resynchronization was achieved. CRT responders were defined using standard criteria 6 months after implantation. Results: Both groups underwent CRT implant with no complications. In Group 1, intraprocedural optimal resynchronization by VVI including visual algorithms and MD-TTP was a predictor discriminating CRT response with a sensitivity of 95% and specificity of 89%. Use of ICE/VVI increased number of and predicted CRT responders (82% in Group 1 vs 63% in Group 2; OR = 2.68, 95% CI 1.08-6.65, P = 0.03). Conclusion: ICE can be safely performed during CRT implantation. "Real-time" VVI appears to be helpful in determining the final LV lead position and pacing mode that allow better intraprocedural resynchronization. VVI-optimized acute resynchronization predicts CRT response and this approach is associated with higher number of CRT responders.

Original languageEnglish (US)
Pages (from-to)1034-1041
Number of pages8
JournalJournal of cardiovascular electrophysiology
Issue number9
StatePublished - Sep 2011
Externally publishedYes


  • cardiac resynchronization therapy
  • heart failure
  • intracardiac echocardiography
  • strain
  • vector velocity imaging

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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