Optimizing CRT Lead Placement Accuracy With CMR-Guided On-Screen Targeting: A Randomized Controlled Trial (ADVISE-CRT III)

Willem Gerrits; Philippe C Wouters; Cheyenne S L Chiu; Marco Guglielmo; Maarten J Cramer; Pim van der Harst; Kevin Vernooy; Antonius M W van Stipdonk; Vokko P van Halm; Vincent F van Dijk; Abdul Ghani; Alexander H Maass; Sing-Cien Yap; Frebus J van Slochteren; Mathias Meine

doi:10.1016/j.jacep.2025.01.022

Optimizing CRT Lead Placement Accuracy With CMR-Guided On-Screen Targeting: A Randomized Controlled Trial (ADVISE-CRT III)

Willem Gerrits^*, Philippe C Wouters, Cheyenne S L Chiu, Marco Guglielmo, Maarten J Cramer, Pim van der Harst, Kevin Vernooy, Antonius M W van Stipdonk, Vokko P van Halm, Vincent F van Dijk, Abdul Ghani, Alexander H Maass, Sing-Cien Yap, Frebus J van Slochteren, Mathias Meine

^*Corresponding author for this work

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Abstract

BACKGROUND: To improve cardiac resynchronization therapy (CRT) an on-screen image-guidance platform, CARTBox-Suite (CART-Tech B.V.), was developed to identify left ventricular pacing electrode (LVPE) implantation sites and facilitate precise LVPE placement. This multicenter randomized trial evaluated the efficacy of image guidance on LVPE implantation accuracy and its impact on left ventricular end-systolic volume (LVESV) reduction 6 months after CRT.

OBJECTIVES: The aim of this trial is to improve the accuracy and efficacy of LVPE placement in CRT.

METHODS: A total of 131 heart failure patients (80% with Class I CRT indication) were enrolled across 7 hospitals in the Netherlands. CARTBox-Suite, which utilizes a cloud-based AI algorithm, was used to identify a target area with late mechanical activation based on cardiac magnetic resonance imaging. Scarred areas marked by late gadolinium enhancement were excluded. Patients were randomized to image-guided implantation, with on-screen guidance during the procedure or conventional implantation.

RESULTS: The primary endpoint, LVPE implantation in the target area, was achieved significantly more often in the image-guided group (66.7% vs 29.2%; P < 0.001). The secondary endpoint was fewer LVPE placed in scarred areas in the image-guided group (7.1% vs 36.4%; P = 0.006). Mean LVESV reduction was greater in the image-guided group (43.2% vs. 37.6%), although not significantly (P = 0.166). Patients with myocardial scar showed greater LVESV reduction with image guidance (40.7% vs 27.7%; P = 0.028).

CONCLUSIONS: Image-guided implantation resulted in significantly more LVPE placed in the target area and greater LVESV reduction in patients with myocardial scar.

Original language	English
Journal	JACC: Clinical Electrophysiology
DOIs	https://doi.org/10.1016/j.jacep.2025.01.022
Publication status	E-pub ahead of print - 3-Mar-2025

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Gerrits, W., Wouters, P. C., Chiu, C. S. L., Guglielmo, M., Cramer, M. J., van der Harst, P., Vernooy, K., van Stipdonk, A. M. W., van Halm, V. P., van Dijk, V. F., Ghani, A., Maass, A. H., Yap, S.-C., van Slochteren, F. J., & Meine, M. (2025). Optimizing CRT Lead Placement Accuracy With CMR-Guided On-Screen Targeting: A Randomized Controlled Trial (ADVISE-CRT III). JACC: Clinical Electrophysiology. Advance online publication. https://doi.org/10.1016/j.jacep.2025.01.022

@article{191b653db4004a3ca986587f8c8cc3da,

title = "Optimizing CRT Lead Placement Accuracy With CMR-Guided On-Screen Targeting: A Randomized Controlled Trial (ADVISE-CRT III)",

abstract = "BACKGROUND: To improve cardiac resynchronization therapy (CRT) an on-screen image-guidance platform, CARTBox-Suite (CART-Tech B.V.), was developed to identify left ventricular pacing electrode (LVPE) implantation sites and facilitate precise LVPE placement. This multicenter randomized trial evaluated the efficacy of image guidance on LVPE implantation accuracy and its impact on left ventricular end-systolic volume (LVESV) reduction 6 months after CRT.OBJECTIVES: The aim of this trial is to improve the accuracy and efficacy of LVPE placement in CRT.METHODS: A total of 131 heart failure patients (80% with Class I CRT indication) were enrolled across 7 hospitals in the Netherlands. CARTBox-Suite, which utilizes a cloud-based AI algorithm, was used to identify a target area with late mechanical activation based on cardiac magnetic resonance imaging. Scarred areas marked by late gadolinium enhancement were excluded. Patients were randomized to image-guided implantation, with on-screen guidance during the procedure or conventional implantation.RESULTS: The primary endpoint, LVPE implantation in the target area, was achieved significantly more often in the image-guided group (66.7% vs 29.2%; P < 0.001). The secondary endpoint was fewer LVPE placed in scarred areas in the image-guided group (7.1% vs 36.4%; P = 0.006). Mean LVESV reduction was greater in the image-guided group (43.2% vs. 37.6%), although not significantly (P = 0.166). Patients with myocardial scar showed greater LVESV reduction with image guidance (40.7% vs 27.7%; P = 0.028).CONCLUSIONS: Image-guided implantation resulted in significantly more LVPE placed in the target area and greater LVESV reduction in patients with myocardial scar.",

author = "Willem Gerrits and Wouters, {Philippe C} and Chiu, {Cheyenne S L} and Marco Guglielmo and Cramer, {Maarten J} and {van der Harst}, Pim and Kevin Vernooy and {van Stipdonk}, {Antonius M W} and {van Halm}, {Vokko P} and {van Dijk}, {Vincent F} and Abdul Ghani and Maass, {Alexander H} and Sing-Cien Yap and {van Slochteren}, {Frebus J} and Mathias Meine",

year = "2025",

month = mar,

day = "3",

doi = "10.1016/j.jacep.2025.01.022",

language = "English",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

publisher = "Elsevier",

}

Gerrits, W, Wouters, PC, Chiu, CSL, Guglielmo, M, Cramer, MJ, van der Harst, P, Vernooy, K, van Stipdonk, AMW, van Halm, VP, van Dijk, VF, Ghani, A, Maass, AH, Yap, S-C, van Slochteren, FJ & Meine, M 2025, 'Optimizing CRT Lead Placement Accuracy With CMR-Guided On-Screen Targeting: A Randomized Controlled Trial (ADVISE-CRT III)', JACC: Clinical Electrophysiology. https://doi.org/10.1016/j.jacep.2025.01.022

TY - JOUR

T1 - Optimizing CRT Lead Placement Accuracy With CMR-Guided On-Screen Targeting

T2 - A Randomized Controlled Trial (ADVISE-CRT III)

AU - Gerrits, Willem

AU - Wouters, Philippe C

AU - Chiu, Cheyenne S L

AU - Guglielmo, Marco

AU - Cramer, Maarten J

AU - van der Harst, Pim

AU - Vernooy, Kevin

AU - van Stipdonk, Antonius M W

AU - van Halm, Vokko P

AU - van Dijk, Vincent F

AU - Ghani, Abdul

AU - Maass, Alexander H

AU - Yap, Sing-Cien

AU - van Slochteren, Frebus J

AU - Meine, Mathias

PY - 2025/3/3

Y1 - 2025/3/3

N2 - BACKGROUND: To improve cardiac resynchronization therapy (CRT) an on-screen image-guidance platform, CARTBox-Suite (CART-Tech B.V.), was developed to identify left ventricular pacing electrode (LVPE) implantation sites and facilitate precise LVPE placement. This multicenter randomized trial evaluated the efficacy of image guidance on LVPE implantation accuracy and its impact on left ventricular end-systolic volume (LVESV) reduction 6 months after CRT.OBJECTIVES: The aim of this trial is to improve the accuracy and efficacy of LVPE placement in CRT.METHODS: A total of 131 heart failure patients (80% with Class I CRT indication) were enrolled across 7 hospitals in the Netherlands. CARTBox-Suite, which utilizes a cloud-based AI algorithm, was used to identify a target area with late mechanical activation based on cardiac magnetic resonance imaging. Scarred areas marked by late gadolinium enhancement were excluded. Patients were randomized to image-guided implantation, with on-screen guidance during the procedure or conventional implantation.RESULTS: The primary endpoint, LVPE implantation in the target area, was achieved significantly more often in the image-guided group (66.7% vs 29.2%; P < 0.001). The secondary endpoint was fewer LVPE placed in scarred areas in the image-guided group (7.1% vs 36.4%; P = 0.006). Mean LVESV reduction was greater in the image-guided group (43.2% vs. 37.6%), although not significantly (P = 0.166). Patients with myocardial scar showed greater LVESV reduction with image guidance (40.7% vs 27.7%; P = 0.028).CONCLUSIONS: Image-guided implantation resulted in significantly more LVPE placed in the target area and greater LVESV reduction in patients with myocardial scar.

AB - BACKGROUND: To improve cardiac resynchronization therapy (CRT) an on-screen image-guidance platform, CARTBox-Suite (CART-Tech B.V.), was developed to identify left ventricular pacing electrode (LVPE) implantation sites and facilitate precise LVPE placement. This multicenter randomized trial evaluated the efficacy of image guidance on LVPE implantation accuracy and its impact on left ventricular end-systolic volume (LVESV) reduction 6 months after CRT.OBJECTIVES: The aim of this trial is to improve the accuracy and efficacy of LVPE placement in CRT.METHODS: A total of 131 heart failure patients (80% with Class I CRT indication) were enrolled across 7 hospitals in the Netherlands. CARTBox-Suite, which utilizes a cloud-based AI algorithm, was used to identify a target area with late mechanical activation based on cardiac magnetic resonance imaging. Scarred areas marked by late gadolinium enhancement were excluded. Patients were randomized to image-guided implantation, with on-screen guidance during the procedure or conventional implantation.RESULTS: The primary endpoint, LVPE implantation in the target area, was achieved significantly more often in the image-guided group (66.7% vs 29.2%; P < 0.001). The secondary endpoint was fewer LVPE placed in scarred areas in the image-guided group (7.1% vs 36.4%; P = 0.006). Mean LVESV reduction was greater in the image-guided group (43.2% vs. 37.6%), although not significantly (P = 0.166). Patients with myocardial scar showed greater LVESV reduction with image guidance (40.7% vs 27.7%; P = 0.028).CONCLUSIONS: Image-guided implantation resulted in significantly more LVPE placed in the target area and greater LVESV reduction in patients with myocardial scar.

U2 - 10.1016/j.jacep.2025.01.022

DO - 10.1016/j.jacep.2025.01.022

M3 - Article

C2 - 40117420

SN - 2405-500X

JO - JACC: Clinical Electrophysiology

JF - JACC: Clinical Electrophysiology

ER -

Optimizing CRT Lead Placement Accuracy With CMR-Guided On-Screen Targeting: A Randomized Controlled Trial (ADVISE-CRT III)

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