{"id":"4cdcb8c87a4c","type":"article","url":"https://hartvaat.nl/2019/09/01/elektrisch-versus-beeldvorming-geleide-lv-leadplaatsing-bij-crt-gerandomiseerde-/","title":"Elektrisch versus beeldvorming-geleide LV-leadplaatsing bij CRT: gerandomiseerde trial","title_en":"Electrically vs. imaging-guided left ventricular lead placement in cardiac resynchronization therapy: a randomized controlled trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euz184","source_url":"https://doi.org/10.1093/europace/euz184","authors":["Charlotte Stephansen","Anders Sommer","Mads Brix Kronborg","Jesper Møller Jensen","Bjarne Linde Nørgaard","Christian Gerdes","Jens Kristensen","Henrik Kjærulf Jensen","Daniel Benjamin Fyenbo","Kirsten Bouchelouche","Jens Cosedis Nielsen"],"significance":5,"published":"2019-09-01","source_date":"2019-09-01","image":"","kennis":[],"congress":"","summary_en":"This double-blinded randomized trial compared electrically guided with imaging-guided LV lead placement for CRT, testing whether combining both optimization techniques improves resynchronization outcomes.","created":"2026-07-03T10:28:08Z","updated":"2026-07-03T13:27:19Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Gerandomiseerde trial die elektrisch geleide vergeleek met beeldvorming-geleide linkerkamer leadplaatsing bij CRT.","abstract_original":"AIMS: To test in a double-blinded, randomized trial whether the combination of electrically guided left ventricular (LV) lead placement and post-implant interventricular pacing delay (VVd) optimization results in superior increase in LV ejection fraction (LVEF) in cardiac resynchronization therapy (CRT) recipients. METHODS AND RESULTS: Stratified according to presence of ischaemic heart disease, 122 patients were randomized 1:1 to LV lead placement targeted towards the latest electrically activated segment identified by systematic mapping of the coronary sinus tributaries during CRT implantation combined with post-implant VVd optimization (intervention group) or imaging-guided LV lead implantation by cardiac computed tomography venography, 82Rubidium myocardial perfusion imaging and speckle tracking echocardiography targeting the LV lead towards the latest mechanically activated non-scarred myocardial segment (control group). Follow-up was 6 months. Primary endpoint was absolute increase in LVEF. Additional outcome measures were changes in New York Heart Association class, 6-minute walk test, and quality of life, LV reverse remodelling, and device related complications. Analysis was intention-to-treat. A larger increase in LVEF was observed in the intervention group (11 ± 10 vs. 7 ± 11%; 95% confidence interval 0.4-7.9%, P = 0.03); when adjusting for pre-specified baseline covariates this difference did not maintain statistical significance (P = 0.09). Clinical response, LV reverse remodelling, and complication rates did not differ between treatment groups. CONCLUSION: Electrically guided CRT implantation appeared non-inferior to an imaging-guided strategy considering the outcomes of change in LVEF, LV reverse remodelling and clinical response. Larger long-term studies are warranted to investigate the effect of an electrically guided CRT strategy."}