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Impact of right-ventricular apical pacing on the optimal left-ventricular lead positions measured by phase analysis of SPECT myocardial perfusion imaging

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The use of SPECT phase analysis to optimize left-ventricular (LV) lead positions for cardiac resynchronization therapy (CRT) was performed at baseline, but CRT works as simultaneous right ventricular (RV) and LV pacing. The aim of this study was to assess the impact of RV apical (RVA) pacing on optimal LV lead positions measured by SPECT phase analysis.

Methods

This study prospectively enrolled 46 patients. Two SPECT myocardial perfusion scans were acquired under sinus rhythm with complete left bundle branch block and RVA pacing, respectively, following a single injection of 99mTc-sestamibi. LV dyssynchrony parameters and optimal LV lead positions were measured by the phase analysis technique and then compared between the two scans.

Results

The LV dyssynchrony parameters were significantly larger with RVA pacing than with sinus rhythm (p ~0.01). In 39 of the 46 patients, the optimal LV lead positions were the same between RVA pacing and sinus rhythm (kappa = 0.861). In 6 of the remaining 7 patients, the optimal LV lead positions were along the same radial direction, but RVA pacing shifted the optimal LV lead positions toward the base.

Conclusion

The optimal LV lead positions measured by SPECT phase analysis were consistent, no matter whether the SPECT images were acquired under sinus rhythm or RVA pacing. In some patients, RVA pacing shifted the optimal LV lead positions toward the base. This study supports the use of baseline SPECT myocardial perfusion imaging to optimize LV lead positions to increase CRT efficacy.

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Acknowledgement

This study was supported in part by grants from the Taiwan National Science Council (NSC 101-2314-B-758-002 and NSC 100-2314-B-075A-005-MY3), a grant from the Taichung Veterans General Hospital (TCVGH-1013105C) and a USA NIH grant (1R01HL094438, PI: Ji Chen, PhD).

Conflicts of interest

Dr. Chen receives royalties from the sale of the Emory Cardiac Toolbox with SyncTool. The terms of this arrangement have been approved by Emory University in accordance with its conflict-of-interest practice.

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Authors and Affiliations

  1. Chang Bing Show Chwan Memorial Hospital, Changhua, Taiwan

    Guang-Uei Hung

  2. Department of Biomedical Imaging and Radiological Science, China Medical University, Taichung, Taiwan

    Guang-Uei Hung

  3. Cardiovascular Center, Taichung Veterans General Hospital, 1650 Taiwan Boulevard Sect. 4, Taichung, Taiwan, 40705

    Jin-Long Huang & Kuo-Yang Wang

  4. Institute of Clinical Medicine, and Cardiovascular Research Institute, Department of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Jin-Long Huang & Shih-Ann Chen

  5. Department of Medicine, School of Medicine, Chung-Shan Medical University, Taichung, Taiwan

    Jin-Long Huang & Kuo-Yang Wang

  6. Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, Taiwan

    Wan-Yu Lin & Shih-Chung Tsai

  7. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan

    Shih-Ann Chen

  8. Department of Radiology and Imaging Sciences, Emory University, Atlanta, GA, USA

    Michael S. Lloyd & Ji Chen

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  1. Guang-Uei Hung
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Correspondence to Jin-Long Huang.

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Hung, GU., Huang, JL., Lin, WY. et al. Impact of right-ventricular apical pacing on the optimal left-ventricular lead positions measured by phase analysis of SPECT myocardial perfusion imaging. Eur J Nucl Med Mol Imaging 41, 1224–1231 (2014). https://doi.org/10.1007/s00259-014-2693-y

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  • DOI: https://doi.org/10.1007/s00259-014-2693-y

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