Left Ventricular Lead Location and Long-Term Outcomes in Cardiac Resynchronization Therapy Patients

Kutyifa, Valentina; Kosztin, Annamária; Klein, Helmut U.; Biton, Yitschak; Nagy, Vivien Klaudia; Solomon, Scott D.; McNitt, Scott; Zaręba, Wojciech; Goldenberg, Ilan; Róka, Attila; Moss, Arthur J.; Merkely, Béla; Singh, Jagmeet P.

doi:10.1016/j.jacep.2018.07.006

Cited by 20 publications

(18 citation statements)

References 24 publications

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“…reported that lateral or posterior LV lead locations are associated with long‐term all‐cause mortality reduction in mild HF patients with CRT‐D and LBBB 18 . Furthermore, non‐apical short axis positions were associated with reductions of the combined endpoint of HF or death, or HF alone compared with the implantable cardioverter defibrillator‐only group 18 . But in this trial, posterior and lateral locations were combined because they found similar outcomes of HF or death in these two groups 18 .…”

Section: Discussionmentioning

confidence: 99%

“…It has been also proposed that LV lead placement is an important determinant of CRT response. Patients with lateral or posterior position showed a better long‐term outcome in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT‐CRT) trial in the composite endpoint of HF or death from any cause and in all‐cause mortality alone compared with implantable cardioverter defibrillator alone, while anterior location was associated with a significantly lower risk of the composite endpoint, but not in death from any cause 18 …”

Section: Introductionmentioning

confidence: 99%

“…Patients with lateral or posterior position showed a better long-term outcome in the Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy (MADIT-CRT) trial in the composite endpoint of HF or death from any cause and in all-cause mortality alone compared with implantable cardioverter defibrillator alone, while anterior location was associated with a significantly lower risk of the composite endpoint, but not in death from any cause. 18 Besides LV lead placement, few smaller studies have indicated that the duration between the electrical signals of the LV and right ventricular (RV) leads predicted echocardiographic improvement and clinical outcome, [19][20][21][22][23][24][25][26][27] because IED does not only show the positions of the ventricular leads, but also contains the electrical dyssynchrony and prolonged activation pattern derived from the slow conduction due to, for example, scar tissue. [19][20][21][22][23][24][25][26][27] The IED is strongly associated with response in terms of reverse remodelling and HF hospitalization after CRT implantation and can be easily measured during lead placement.…”

Section: Introductionmentioning

confidence: 99%

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Lateral left ventricular lead position is superior to posterior position in long‐term outcome of patients who underwent cardiac resynchronization therapy

et al. 2020

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Aims Preferring side branch of coronary sinus during cardiac resynchronization therapy (CRT) implantation has been empirical due to the limited data on the association of left ventricular (LV) lead position and long-term clinical outcome. We evaluated the long-term all-cause mortality by LV lead non-apical positions and further characterized them by interlead electrical delay (IED). Methods and results In our retrospective database, 2087 patients who underwent CRT implantation were registered between 2000 and 2018. Those with non-apical LV lead locations were classified into anterior (n = 108), posterior (n = 643), and lateral (n = 1336) groups. All-cause mortality was assessed by Kaplan-Meier and Cox analyses. Echocardiographic response was measured 6 months after CRT implantation. During the median follow-up time of 3.7 years, 1150 (55.1%) patients died-710 (53.1%) with lateral, 78 (72.2%) with anterior, and 362 (56.3%) with posterior positions. When we investigated the risk of all-cause mortality, there was a significantly lower rate of death in patients with lateral LV lead location when compared with those with an anterior (P < 0.01) or posterior (P < 0.01) position. Multivariate analysis after adjustment for relevant clinical covariates such as age, sex, ischaemic aetiology, left bundle branch block morphology, atrial fibrillation, and device type revealed consistent results that lateral position is associated with a significant risk reduction of all-cause mortality when compared with anterior [hazard ratio 0.69; 95% confidence interval (CI) 0.55-0.87; P < 0.01] or posterior (hazard ratio 0.84; 95% CI 0.74-0.96; P < 0.01) position. When echocardiographic response was evaluated within the lateral group, patients with an IED longer than 110 ms (area under the receiver operating characteristic curve, 0.63; 95% CI 0.53-0.73; P = 0.012) showed 2.1 times higher odds of improvement in echocardiographic response 6 months after the implantation. Conclusions In this study, we proved in a real-world patient population that after CRT implantation, lateral LV lead location was associated with long-term mortality benefit and is superior to both anterior and posterior positions. Moreover, patients with this position showed the greatest echocardiographic response over 110 ms IED.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Lateral left ventricular lead position is superior to posterior position in long‐term outcome of patients who underwent cardiac resynchronization therapy

et al. 2020

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“…These data suggest that apical LV lead placement is associated with worse CRT outcomes and preferential positioning of LV leads in the basal/midventricle segments would be a choice in order to improve the outcomes. These results were also highlighted in a substudy analysis of the MADIT-CRT study [25,29].…”

Section: Anatomical Positioning: Segmental Pacing Sitementioning

confidence: 60%

The Importance of Lead Positioning to Improve Clinical Outcomes in Cardiac Resynchronization Therapy

Stoia¹,

Istrătoaie²,

Pop³

et al. 2019

Cardiac Diseases and Interventions in 21st Century

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Left ventricular (LV) lead positioning is one of the main contributors to the cardiac resynchronization therapy (CRT) response. Conventional left ventricular (LV) lead implantation faces several difficulties, which may ultimately affect lead stability and performance. Several imaging techniques have been proposed to overcome all these obstacles including multimodality cardiac imaging to help in preprocedural or intraprocedural identification of the latest activated areas of the LV. Emerging pacing strategies like LV multisite and multipoint pacing may help deliver an enhanced response to CRT, but prospective trials are warranted to confirm the superiority of this approach.

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“…In general, a lateral vein was selected as the target vessel for the LV lead (anatomy-guided), as it most frequently presents the latest activated region. 11,12 LV pacing at the site of latest activation has been shown to enhance resynchronization and is associated with long-term HF improvement and mortality reduction, 13 as well as improvement in functional capacity and LVEF. 14…”

Section: Implant Proceduresmentioning

confidence: 99%

Modified snare technique improves left ventricular lead implant success for cardiac resynchronization therapy

Marques

Nunes-Ferreira

Antonio

et al. 2020

Cardiovasc electrophysiol

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Background Left ventricular (LV) lead placement is the most challenging aspect of cardiac resynchronization therapy (CRT) device implantation, with a failure rate of up to 10% due to complex coronary anatomies. We describe a modified snare technique for LV lead placement and evaluate its safety and efficacy in cases when standard methods fail. Methods and Results A prospective study was conducted of patients indicated for a CRT implant. When LV lead delivery to the target vessel failed using standard techniques, a modified snare technique was employed. Patients were evaluated every 6 months. From 2015 to 2019, 566 CRTs were implanted (26.1% female, 72 ± 10.2 years old, follow‐up duration 18.9 ± 15.8 months). The standard LV implant technique failed in 94 cases (16.6%), of which the modified snare technique was successful in 92 (97.9%). There were no differences between the modified snare and standard techniques in the rates of 30‐day postimplant CRT all‐cause mortality (3.2% vs. 1.7%, p = .33), 4‐year all‐cause mortality (15.9% vs. 15.5%, p = .49), or major acute complications (7.4% vs. 3.8%, p = .12). However, the 4‐year procedural reintervention rate was lower with the modified snare technique (3.2% vs. 10.2%, p < .05), specifically LV implant failure or dislodgement rates (0% vs. 5.3%, p < .05), improving the response rate (71.8% vs. 55.1%, p < .05). Conclusions For challenging coronary sinus anatomies that preclude LV lead placement by standard methods, this modified snare alternative was safe and effective, with comparable mortality and complications, but significantly lower procedural reintervention and higher response rates.

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Left Ventricular Lead Location and Long-Term Outcomes in Cardiac Resynchronization Therapy Patients

Cited by 20 publications

References 24 publications

Lateral left ventricular lead position is superior to posterior position in long‐term outcome of patients who underwent cardiac resynchronization therapy

Lateral left ventricular lead position is superior to posterior position in long‐term outcome of patients who underwent cardiac resynchronization therapy

The Importance of Lead Positioning to Improve Clinical Outcomes in Cardiac Resynchronization Therapy

Modified snare technique improves left ventricular lead implant success for cardiac resynchronization therapy

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