Multidetector Cardiac CT to guide CRT implantation
Research type
Research Study
Full title
Multidetector Cardiac Computed Tomography for image guided Cardiac Resynchronisation Therapy (CRT): Utilising coronary venous anatomy, myocardial scar and dyssynchrony data in patients receiving CRT upgrade. A validation study against the acute haemodynamic response.
IRAS ID
150161
Contact name
Reza Razavi
Contact email
Sponsor organisation
King's College London
Research summary
This is a proof of concept study involving image guidance of Cardiac Resynchronisation Therapy (CRT) using cardiac CT. CRT is a specialised type of pacemaker which is an effective treatment for certain patients with heart failure. It is a procedure carried out in the cardiac catheter lab and is usually performed using real-time X-Ray screening to help guide the placement of the pacemaker leads. We know however, that despite many advances in medicine approximately a third of patients undergoing CRT do not improve. We believe this is due to the empirical positioning of the lead on the left side of the heart. We believe that by achieving optimal positioning of the lead, we may be able to improve the success of this procedure.
Specifically this study will assess the feasibility of an image guided approach, utilising pre procedural cardiac CT scanning. These images will be reviewed prior to the procedure in order to improve lead placement and improve procedural success. We believe that by avoiding scar tissue and targeting the most dys-synchronous segments, we can improve the success of this procedure.
We will validate this method against an acute measurement called the acute haemodynamic response (AHR). This is a way of seeing the real-time effects of placing the left sided pacing lead at different positions within the heart, upon heart function. We have already demonstrated that the AHR is a good measure of clinical improvement further down the line (6 months) and is therefore a good way of acutely predicting whether placement of a lead in a specific spot is likely to help the patient or not. We have shown this with MRI however, patients with a pre existing pacemaker cannot undergo effective cardiac MRI and CT scanning may provide an alternative method.
REC name
West Midlands - Coventry & Warwickshire Research Ethics Committee
REC reference
14/WM/1069
Date of REC Opinion
11 Aug 2014
REC opinion
Further Information Favourable Opinion