Left ventricular lead position, mechanical activation, and myocardial scar in relation to left ventricular reverse remodeling and clinical outcomes after cardiac resynchronization therapy: A feature-tracking and contrast-enhanced cardiovascular magnetic resonance study

Taylor, Robin J.; Umar, Fraz; Panting, Jonathan; Stegemann, Berthold; Leyva, Francisco

doi:10.1016/j.hrthm.2015.10.024

Cited by 64 publications

(49 citation statements)

References 24 publications

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“…LV lead placement at a scar-free site 8,17 possibly mechanically 12 or electrically delayed (Fig. 3 panel B) improve RR up to 70% of patients.…”

Section: Discussionmentioning

confidence: 98%

“…Under this perspective, the use of AFL enhances the capability of targeted LV lead placement 4 while ensuring stability over the long term (Table 3), possibly improving the clinical outcome (Table 3). This is particularly important as only 35% of patients have more than a single coronary vein suitable to LV lead placement 6 , and QL leads may not be successfully implanted in up to 7% of patients 17,18 . Despite these considerations in our study the “novel technologies”, while significantly increasing RR, failed to show an improvement in clinical composite score.…”

Section: Discussionmentioning

confidence: 99%

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Cardiac resynchronization therapy: a comparison among left ventricular bipolar, quadripolar and active fixation leads

Ziacchi

Diemberger

Corzani

et al. 2018

Sci Rep

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We evaluated the performance of 3 different left ventricular leads (LV) for resynchronization therapy: bipolar (BL), quadripolar (QL) and active fixation leads (AFL). We enrolled 290 consecutive CRTD candidates implanted with BL (n = 136) or QL (n = 97) or AFL (n = 57). Over a minimum 10 months follow-up, we assessed: (a) composite technical endpoint (TE) (phrenic nerve stimulation at 8 V@0.4 ms, safety margin between myocardial and phrenic threshold <2V, LV dislodgement and failure to achieve the target pacing site), (b) composite clinical endpoint (CE) (death, hospitalization for heart failure, heart transplantation, lead extraction for infection), (c) reverse remodeling (RR) (reduction of end systolic volume >15%). Baseline characteristics of the 3 groups were similar. At follow-up the incidence of TE was 36.3%, 14.3% and 19.9% in BL, AFL and QL, respectively (p < 0.01). Moreover, the incidence of RR was 56%, 64% and 68% in BL, AFL and QL respectively (p = 0.02). There were no significant differences in CE (p = 0.380). On a multivariable analysis, “non-BL leads” was the single predictor of an improved clinical outcome. QL and AFL are superior to conventional BL by enhancing pacing of the target site: AFL through prevention of lead dislodgement while QL through improved management of phrenic nerve stimulation.

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“…LV lead placement at a scar-free site 8,17 possibly mechanically 12 or electrically delayed (Fig. 3 panel B) improve RR up to 70% of patients.…”

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Cardiac resynchronization therapy: a comparison among left ventricular bipolar, quadripolar and active fixation leads

Ziacchi

Diemberger

Corzani

et al. 2018

Sci Rep

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“…However, measuring scar burden is currently a challenging task. There have been prior studies assessing outcomes to CRT-D by scar burden measured by strain echocardiography imaging, positron emis- [16,17]. Our study is unique in regarding the use of a simple clinical parameter, the number of prior revascularization procedures, as a surrogate marker for the burden of nonviable myocardium.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of cardiac resynchronization therapy by the frequency of revascularization procedures in ischemic cardiomyopathy patients

et al. 2016

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Background: It is not known whether the number of revascularizations modifies clinical outcomes in patients with ischemic cardiomyopathy (ICM) implanted with cardiac resynchronization therapy defibrillator (CRT-D) vs. an implantable cardioverter-defibrillator (ICD)-only. Methods: In Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT), we evaluated the effect of CRT-D vs. ICD-only on heart failure (HF) or death, on ventricular tachycardia (VT), ventricular fibrillation (VF) or death, and on ]; p < 0.001). Similarly, there was a risk reduction of VT/ /VF/death with CRT-D vs. ICD-only in patients with no need for revascularization ; p = 0.044); with 1 revascularization ]; p = 0.23); or with ≥ 2 revascularizations ; p = 0.14). There was a similar degree of left ventricular reverse remodeling in all three LVEDV, (Cardiol J 2016; 23, 4: 437-445)

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“…Recent studies using cardiac MRI to identify areas of scar and late mechanical activation and concordant LV lead placement suggest benefit in terms of LV reverse remodelling, cardiac mortality and heart failure hospitalisations 37. If a patient is initially selected using guideline-directed indications, then performing additional preimplant imaging to optimise lead positioning during the procedure is reasonable.…”

Section: Non-responders and Basic Troubleshootingmentioning

confidence: 99%

Cardiac resynchronisation therapy: current indications, management and basic troubleshooting

Rao

Faddis²

2017

Heart

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Left ventricular lead position, mechanical activation, and myocardial scar in relation to left ventricular reverse remodeling and clinical outcomes after cardiac resynchronization therapy: A feature-tracking and contrast-enhanced cardiovascular magnetic resonance study

Cited by 64 publications

References 24 publications

Cardiac resynchronization therapy: a comparison among left ventricular bipolar, quadripolar and active fixation leads

Cardiac resynchronization therapy: a comparison among left ventricular bipolar, quadripolar and active fixation leads

Effectiveness of cardiac resynchronization therapy by the frequency of revascularization procedures in ischemic cardiomyopathy patients

Cardiac resynchronisation therapy: current indications, management and basic troubleshooting

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