Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2025 Jun;11(6):1293-1305.
doi: 10.1016/j.jacep.2025.01.022. Epub 2025 Mar 19.

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

Willem Gerrits  1 , Philippe C Wouters  2 , Cheyenne S L Chiu  2 , Marco Guglielmo  3 , Maarten J Cramer  2 , Pim van der Harst  2 , Kevin Vernooy  4 , Antonius M W van Stipdonk  4 , Vokko P van Halm  5 , Vincent F van Dijk  6 , Abdul Ghani  7 , Alexander H Maass  8 , Sing-Cien Yap  9 , Frebus J van Slochteren  10 , Mathias Meine  2
Affiliations
Free article
Randomized Controlled Trial

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

Willem Gerrits et al. JACC Clin Electrophysiol. 2025 Jun.
Free article

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.

Keywords: cardiac resynchronization therapy; heart failure; image guidance; magnetic resonance imaging; precision medicine.

PubMed Disclaimer

Conflict of interest statement

Funding Support and Author Disclosures This work was supported by ZonMW, grant number 40-44600-98-327. Dr Guglielmo is a sponsored speaker for Philips. Dr van Slochteren is a cofounder and shareholder of CART-Tech BV. Dr van Slochteren and Dr Meine are inventors and beneficiaries of a patent license arrangement between the University Medical Center Utrecht and CART-Tech BV, according to the rules of the University Medical Center Utrecht. Dr Yap has received honoraria (speaker or consultancy fees) from Boston Scientific, Medtronic, Biotronik, Acutus Medical, and Sanofi; and has received research grants from Medtronic, Biotronik, and Boston Scientific. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Publication types