Left ventricular lead electrical delay predicts response to cardiac resynchronization therapy

Singh, Jagmeet P.; Ding, Fan; Heist, E. Kevin; Alabiad, Chrisfouad R.; Taub, Cynthia C.; Reddy, Vivek Y.; Mansour, Moussa; Picard, Michael H.; Ruskin, Jeremy N.; Mela, Theofanie

doi:10.1016/j.hrthm.2006.07.034

Cited by 241 publications

(191 citation statements)

References 24 publications

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“…Singh et al, devised a measure of electrical latency called the left ventricular lead electrical delay (LVLED) [20]. This marker of electrical delay was calculated during LV lead implantation by determining the onset of the surface ECG-QRS complex to the onset of the sensed electrogram on the LV lead and expressing the value (the Q-LV time) as a percentage of the baseline QRS interval.…”

Section: Identifying the Site Of Latest Electrical Activation (Lea)mentioning

confidence: 99%

“…Electrical latency appears a useful marker when looking to identify the optimal LV pacing site [19,20], and a similar approach can also be used when looking to optimize RV lead position. In the INTER-V study, the measurement of paced RV-LV interlead electrical delay predicted mid-term CRT response [122].…”

Section: Identifying the Site Of Latest Electrical Activation (Lea)mentioning

confidence: 99%

“…It is not clear whether this approach is superior to targeting sites of electrical latency or even whether these two sites are synonymous [112]. Both Q-LV [19] and LVLED [20] appear particularly useful markers to aid site selection. Neither technique requires sophisticated electroanatomical mapping or additional pre-procedural image processing and instead can be calculated by the operator at the time of LV lead deployment.…”

Section: Expert Commentarymentioning

confidence: 99%

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Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

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Introduction: Cardiac resynchronization therapy (CRT) has emerged as one of the few effective treatments for heart failure. However, up to 50% of patients derive no benefit. Suboptimal left ventricle (LV) lead position is a potential cause of poor outcomes while targeted lead deployment has been associated with enhanced response rates. Image-fusion guidance systems represent a novel approach to CRT delivery, allowing physicians to both accurately track and target a specific location during LV lead deployment.Areas covered: This review will provide a comprehensive evaluation of how to define the optimal pacing site. We will evaluate the evidence for delivering targeted LV stimulation at sites displaying favorable viability or advantageous mechanical or electrical properties. Finally, we will evaluate several emerging image-fusion guidance systems which aim to facilitate optimal site selection during CRT.Expert commentary: Targeted LV lead deployment is associated with reductions in morbidity and mortality. Assessment of tissue characterization and electrical latency are critical and can be achieved in a number of ways. Ultimately, the constraints of coronary sinus anatomy have forced the exploration of novel means of delivering CRT including endocardial pacing which hold promise for the future of CRT delivery.

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Section: Identifying the Site Of Latest Electrical Activation (Lea)mentioning

confidence: 99%

Section: Identifying the Site Of Latest Electrical Activation (Lea)mentioning

confidence: 99%

Section: Expert Commentarymentioning

confidence: 99%

See 1 more Smart Citation

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Sieniewicz

Gould

Porter

et al. 2018

Expert Review of Medical Devices

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show abstract

“…[13][14][15] LV lead implantation into the recommended lateral or posterolateral side branch of the CS is not feasible due to anatomical and/or technical limitations in up to one-third of patients. 16 An important cause of suboptimal lead positioning, lead dislodgement, or extracardiac stimulation is the unstable electrode position in the target vein.…”

Section: Discussionmentioning

confidence: 99%

Long-term experience with coronary sinus side branch stenting to stabilize left ventricular electrode position

et al. 2011

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BACKGROUND Despite technical advancements, implantation of coronary sinus (CS) leads may be challenging, and dislocation remains a relevant clinical problem.OBJECTIVE The aim of this study was to investigate the effectiveness, safety, and long-term outcome of stent implantation to anchor the lead to the wall of the CS side branch. METHODSStenting of a CS side branch was performed in 312 patients. The procedure was performed because of postoperative lead dislocation in 16 patients and because of an intraoperative unstable lead position or phrenic nerve stimulation in 296 cases. A bare metal coronary stent was introduced over a second guide wire in the same CS sheath. The stent was deposited 5-35 mm proximal to the most proximal electrode. Mechanical damage of the CS side branch or pericardial effusion was not observed owing to stenting. RESULTSDuring follow-up (median 28.4, interquartile range 15-37, maximum 70 months), a clinically important increase in the left ventricular pacing threshold was found in four cases and reoperation was necessary in only two patients (0.6%). Phrenic nerve stimulation was observed in 18 instances, and repositioning with an ablation catheter was performed in seven cases. Impedance measurements did not suggest lead insulation failure. Three stented leads were extracted without complication after 3-49 months owing to infection, while four leads were extracted easily during heart transplantation after 7-27 months.CONCLUSION Stent implantation to stabilize CS lead position seems to be an effective and safe procedure in prevention and treatment of CS lead dislocation in selected cases.KEYWORDS Cardiac resynchronization; LV lead implantation; Coronary sinus; Lead dislocation; Stent implantation ABBREVIATIONS CRT ϭ cardiac resynchronization therapy; CS ϭ coronary sinus; INR ϭ international normalized ratio; LV ϭ left ventricle; NYHA ϭ New York Heart Association; PNS ϭ phrenic nerve stimulation (Heart Rhythm 2011;8:845-850)

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“…QLV measurements were made in a unipolar configuration from the tip of the guidewire (cathode), to a retractor in the surgical pocket (anode/ground) using a sterile alligator clip connector attached to the junction box, and were recorded on an EP Workmate™ version 4.3.2 system (Abbott Laboratories, Chicago, IL, USA). QLV was measured using techniques described by Singh et al 9 and Gold et al 3 ; namely, from the onset of the QRS complex to the peak of the first positive or negative deflection that was at least 50% of the total LV electrogram amplitude. Electrograms were recorded at multiple sites in those veins that were of clinical interest as potential targets for CRT pacing and were used to select the target vein for lead placement.…”

Section: Methodsmentioning

confidence: 99%

Guidewire Method for Measuring Local Left Ventricular Electrical Activation Time During Cardiac Resynchronization Implantation

Rials¹,

Pershing²,

Collins³

2017

J Innov Cardiac Rhythm Manage

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ABSTRACT. The timing of local activation at left ventricular (LV) pacing leads is measured from the onset of the QRS complex to the peak of the LV electrogram (QLV). Pacing from the sites of late activation is associated with higher response rates to cardiac resynchronization therapy (CRTtechniques target the posterolateral wall of the left ventricle (LV) using a combination of radiographic appearance, pacing parameters, lead stability, and an absence of diaphragmatic stimulation to determine the final lead position. Unfortunately, CRT is associated with a nonresponder rate of 20% to 40%, depending on the definition used for response. One predictor of response to CRT is the timing of activation measured at the LV electrode relative to the onset of the QRS complex (QLV). Prolonged QLV (QLV > 95 ms) is associated with both an improved acute response to and marked long-term improvement with CRT. 3,4 Prospective measurement of QLV has been described

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Left ventricular lead electrical delay predicts response to cardiac resynchronization therapy

Cited by 241 publications

References 24 publications

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Optimal site selection and image fusion guidance technology to facilitate cardiac resynchronization therapy

Long-term experience with coronary sinus side branch stenting to stabilize left ventricular electrode position

Guidewire Method for Measuring Local Left Ventricular Electrical Activation Time During Cardiac Resynchronization Implantation

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