There is currently no established method for the cardiologist to visualize the two areas of interest during the placement procedure. Because positioning the LV lead is a difficult procedure, targeting the optimal site for LV leads is therefore a process of trial and error for the cardiologist.
When placing the lead, infarcted tissue is to be avoided because little effect can be expected from the stimulation of this dead tissue.
In addition, the LV lead is expected to exert its best effect in an area of the heart that has delayed contraction in comparison to neighboring tissue. CARTBox merges the myocardial infarction area and the LV lead target area with X-ray images of the coronary veins and displays this information real time in a single screen during placement of the lead. As a result, the lead can be placed in a coronary vein in a late contracting area, away from the infarcted tissue (see Figures below).
CARTBox is compatible with any MRI and fluoroscopy device, including older models.
CARTBox navigation in action: observed of the heart in two views: the infarcted (yellow-red) and target (green) areas are visualized to guide real time LV lead implantation. The tip of the lead is visible in the target zone in both views.
Explanation for cardiologists:
The myocardial infarction transmurality (yellow-red) and LV lead target (green) are projected on live fluoroscopy in LAO 45 (left) and AP (right) recordings. The tip electrode of a quadripolar lead is placed in the LV lead target.