Various multi-center trials have shown that cardiac resynchronization therapy (CRT) is an effective procedure
for patients with end-stage drug invariable heart failure (HF). Despite the encouraging results of CRT, at least
30% of patients do not respond to the treatment. Detailed knowledge of the cardiac anatomy (coronary
venous tree, left ventricle), functional parameters (i.e. ventricular synchronicity) is supposed to improve
CRT patient selection and interventional lead placement for reduction of the number of non-responders.
As a pre-interventional imaging modality, cardiac magnetic resonance (CMR) imaging has the potential
to provide all relevant information. With functional information from CMR optimal implantation target
sites may be better identified. Pre-operative CMR could also help to determine whether useful vein target
segments are available for lead placement. Fused with X-ray, the mainstay interventional modality, improved
interventional guidance for lead-placement could further help to increase procedure outcome.
In this contribution, we present novel and practicable methods for a) pre-operative functional and anatomical
imaging of relevant cardiac structures to CRT using CMR, b) 2D-3D registration of CMR anatomy and
functional meshes with X-ray vein angiograms and c) real-time capable breathing motion compensation for
improved fluoroscopy mesh overlay during the intervention based on right ventricular pacer lead tracking.
With these methods, enhanced interventional guidance for left ventricular lead placement is provided.