Medical background

Cardiac resynchronization therapy (CRT) is an advanced pacemaker treatment, which has become standard therapy for patients with heart failure and left ventricular dyssynchrony. The aim of this treatment is to synchronize cardiac contraction by placement of the three stimulation leads in the right atrium (RA), the right ventricle (RV) and in a blood vessel on top of the left ventricle (LV) of the heart. In most HF patients, CRT results in a more synchronous contraction and a better pump function of the heart.

Despite the overall success of CRT in decreasing morbidity and mortality in patients with heart failure, a significant minority (30%) is nonresponsive. It has been shown, also by CART-Tech, that suboptimal LV lead placement is strongly related to a poor response to CRT.

Placement of the LV lead electrode of the CRT device can be difficult and for some cardiologist, selecting the optimal site for the LV lead is a process of trial and error. When placing the LV lead, infarcted issue and its border zone are to be avoided whereas the segment with the largest delay in contraction should be the target. CARTBox provides the solution to target the LV lead to the optimal location.

There is currently no established method to visualize these two areas of interest for the cardiologist during the placement procedure. MRI images can visualize the heart, including myocardial scar tissue and cardiac mechanics. However, MRI cannot be used in real time and cannot visualize the coronary venous system needed for placement of the CRT leads. On the other hand, real-time fluoroscopy (X-Ray) during LV lead placement does not visualize the heart itself, but primarily the coronary venous system.

With CARTBox, the essential data acquired from MRI can be combined with X-Ray imaging during the procedure, visualizing all areas of interest on a single screen.