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Aims: A non-optimal resynchronization lead (RL) position is a possible cause of poor CRT response. The study aims to test the value of real-time-three-dimensional-echocardiography (RT3DE) for individual assessment of LV dyssynchrony and prospective evaluation of CRT response after RL implantation at the pre-determined segment of maximal delay (SMMD) whatever the method of CRT used.Methods: Seventeen HF patients were prospectively included in the study. RT3DE data were obtained before and after 1, 3, 6 months of CRT. Time/volume curves and parametric imaging were applied for pre-implant identification of SMMD and for individual assessment of CRT response. Delta-time delay (delta-t) and selective parameters between tmsv of the latest and earliest activated segments were calculated.Results: All patients received CRT according to accessibility of the SMMD. We used bifocal right ventricular pacing (BFRVP) in 5 patients with septal SMMD; biventricular pacing (BVP) in 12 patients with LV SMMD. The RL was successfully implanted at the SMMD or nearest segment in 14 (82.4%) initial responders (5 BFRVP, 9 BVP). Twelve of them were still responders after 6 months. CRT response was comparable in BFRVP and BIVP. A moderate correlation was found between % change of EF and that of SDI (r = −.406), delta-t (−.497). Baseline delta-t showed a stronger correlation with % change of EF (r = −.718∗∗, P = 0.009) than that of SDI (r = −.509, P = 0.091).Conclusion: The use of RT3DE for individual assessment of LV mechanical dyssynchrony and for optimal RL positioning at the pre-identified SMMD can provide more optimum CRT regardless the method of CRT

the egyptian heart journal /the egyptian heart journal

The role of real time three dimensional echocardiography to guide optimal lead positioning and improve response to cardiac resynchronization therapy: A prospective pilot study