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This slide shows CS lead postion in the present study.
LV lead was positioned in antero-lateral in 17 patients, lateral in 53, post-lat in 28. Improvement of patient symptom assessed by one or more in NYHA functional class was observed 70 to 80%, and no statistical difference was observed among three different groups.
LV reverse remodeling assessed by echocardiographic evaluation was observed in 50 to 60%, and also no statistical difference was observed among three different groups.
This figure demonstrates Kapla-Meire survival curves showing free from re-hospitalization because of worsening heart failure. Approximately 50% of patients experienced re-hospitalization two years after CRT implantation, and there was no significant difference among three groups. This slide shows short axis view of patient with heart failure and CLBBB. You can see significant dysynchrony and very late. excitation in the posterior site. We can suppose that to pace the latest site is the most effective. This slide shows the study by Van de Veire et. al. They performed MDCT and Cornary vein angiography to detect the optimal CV and tissue strain image to detect the latest site for contraction.
These bar graphs show the correction of LV dyssynchrony in patients with and without matching in positioning the LVlead within the area of latest mechanical activation in the pacing site and the mechanical delayed activation.
The favorable effects of a match between lead position and area of latest mechanical activation was observed.
But, how can we integrate the echo image and the CV anatomy?

This slide is the results from the study by Goitein et. al. which is showing integration of multimodal image, such as MDCT and echocardiographical imaging. You can see the relationship between CV anatomy including phrenic nerve and the latest site of mechanical excitation. When you pace the latest area via the lateral vein, patients should respond to CRT.
However, this method requires integration of multiple modalities.
Multiple types of information should be provided by a single modality. The dual source CT with capability to detect LV dyssynchrony will be available in the near future.