Long-term clinical outcome and left ventricular lead position in cardiac resynchronization therapy

Kronborg, Mads Brix; Albertsen, Andi Eie; Nielsen, Jens Cosedis; Mortensen, Peter Thomas

doi:10.1093/europace/eup202

Cited by 33 publications

(26 citation statements)

References 21 publications

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“…Gasparini et al found no difference in NYHA class, 6‐minute walking distance, or LVEF between anterior and posterolateral LV lead positions 15. Similar survival was observed for anterior and posterolateral LV lead positions in other observational studies16 and in the COMPANION (Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure) study 17. These findings are consistent with our observation that circumferential position has no impact on long‐term clinical outcomes.…”

Section: Discussionsupporting

confidence: 90%

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Long‐Term Outcomes of Cardiac Resynchronization Therapy Using Apical Versus Nonapical Left Ventricular Pacing

Leyva

Zegard

Taylor

et al. 2018

JAHA

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BackgroundExperimental evidence indicates that left ventricular (LV) apical pacing is hemodynamically superior to nonapical LV pacing. Some studies have shown that an LV apical lead position is unfavorable in cardiac resynchronization therapy. We sought to determine whether an apical LV lead position influences cardiac mortality after cardiac resynchronization therapy.Methods and ResultsIn this retrospective observational study, the primary end point of cardiac mortality was assessed in relation to longitudinal (basal, midventricular, or apical) and circumferential (anterior, lateral, or posterior) LV lead positions, as well as right ventricular (apical or septal), assigned using fluoroscopy. Lead positions were assessed in 1189 patients undergoing cardiac resynchronization therapy implantation over 15 years. After a median follow‐up of 6.0 years (interquartile range: 4.4–7.7 years), an apical LV lead position was associated with lower cardiac mortality than a nonapical position (adjusted hazard ratio: 0.74; 95% confidence interval, 0.56–0.99) after covariate adjustment. There were no differences in total mortality or heart failure hospitalization. Death from pump failure was lower with apical than nonapical positions (adjusted hazard ratio: 0.69; 95% confidence interval, 0.51–0.94). Compared with a basal position, an apical LV position was also associated with lower risk of sudden cardiac death (adjusted hazard ratio: 0.34; 95% confidence interval, 0.13–0.93). No differences emerged between circumferential LV lead positions or right ventricular positions with respect to any end point.ConclusionsIn recipients of cardiac resynchronization therapy, an apical LV lead position was associated with better long‐term cardiac survival than a nonapical position. This effect was due to a lower risk of pump failure and sudden cardiac death.

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Section: Discussionsupporting

confidence: 90%

“…We should also consider, however, that these techniques were not used in MADIT‐CRT2 or REVERSE 3. Although fluoroscopy may not permit precise localization of lead position, it has nevertheless been used in randomized controlled trials2, 3, 17 and is routinely used in clinical practice worldwide 15, 16…”

Section: Discussionmentioning

confidence: 99%

Long‐Term Outcomes of Cardiac Resynchronization Therapy Using Apical Versus Nonapical Left Ventricular Pacing

Leyva

Zegard

Taylor

et al. 2018

JAHA

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“…10) In this study, the impact of LV lead position at an apical or nonapical location on the CRT response was not signifi cant. However, a presumed optimal LV-Ps still remained an independent predictor for a favorable CRT response after being adjusted for baseline clinical characteristics.…”

Section: Discussionmentioning

confidence: 50%

“…There was little data about the impact of the LV lead position that was combined the short-axis with the longitudinal-axis on CRT response. A study by Kronborg MB, et al 10) revealed that a presumed optimal LV lead position between 2 and 5 o'clock in the short-axis circumference and basal or mid-ventricular in the long axis was not associated with a better clinical CRT response and more favorable prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, a presumed optimal LV-Ps was defined as lateral in the short-axis view (2-5 o'clock) combined with a longitudinal position basal or midventricular. 10) Patients with an absolute increase of at least 5% in left ventricular ejection fraction (LVEF) at 12 months follow-up after CRT implantation compared with the baseline echocardiogram, without heart failure rehospitalization or any cause of death, were classifi ed as CRT-responders. Statistical analysis: Categorical variables are expressed as absolute numbers and percentages, and continuous variables as the mean with standard deviations.…”

Section: )mentioning

confidence: 99%

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Predictors for Cardiac Resynchronization Therapy Response

Zhou

2014

Int. Heart J.

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SummaryAlthough cardiac resynchronization therapy (CRT) is a well-established treatment for a subset of patients with chronic heart failure, a considerable proportion of eligible patients still fail to benefi t from this treatment. The aim of this study was to identify potential independent predictors for being a responder to CRT. A single-center, retrospective analysis was conducted in 193 consecutive patients with heart failure and wide QRS complex who successfully underwent CRT device implantation from January 2006 to October 2012. Clinical characteristics, left ventricular lead position (LVPs), electrocardiography and echocardiography were evaluated before and 12 months after CRT. Response to CRT was defi ned as an absolute increase of ≥ 5% in left ventricular ejection fraction (LVEF) compared with baseline at 12 months after CRT implantation without heart failure rehospitalization or any cause of death. There were 132 responders (68%) and 61 nonresponders (32%). By univariate logistic analysis, the presence of non-left bundle branch block (non-LBBB) and QRS duration, chronic atrial fi brillation (AF), history of ventricular tachycardia (VT), degree of tricuspid regurgitation and left atrium dimension (LAD) at baseline, ΔQRS duration, and LV-Ps were associated with predicting a response to CRT. However, on multivariate analysis, only optimal LV-Ps and presence of non-LBBB remained independently predictive for a CRT response, with an odds ratio of 2.53 (95% confi dence interval [CI]: 1.13-5.66, P = 0.023), 0.15(95% CI: 0.05-0.45, P = 0.001), respectively. Kaplan-Meier analysis revealed that patients with nonoptimal LV-Ps or non-LBBB morphology had a signifi cantly higher rate of mortality or heart failure rehospitalization as compared with those with optimal LV-Ps or LBBB morphology (P < 0.05). (Int Heart J 2014; 55: 256-263)

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Current and future role of cardiovascular magnetic resonance in cardiac resynchronization therapy

Leyva

Foley

2011

Heart Fail Rev

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Cardiac resynchronization therapy (CRT) has revolutionized the treatment of selected patients with systolic heart failure. It is well recognized, however, that the symptomatic response to and the outcome of CRT is highly variable. The degree of pre-implant mechanical dyssynchrony and the extent as well as the localization of myocardial scarring are known to contribute to this variability. Cardiovascular magnetic resonance (CMR) is the gold-standard imaging modality for the assessment of myocardial structure and function. Recently, CMR has also been shown to be useful in assessing cardiac dyssynchrony and in guiding left ventricular lead deployment away from scarred myocardium. This review explores the current role of CMR in risk stratification and in guiding LV lead deployment. The potential of CMR in identifying the arrhythmogenic substrate is also discussed.

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Long-term clinical outcome and left ventricular lead position in cardiac resynchronization therapy

Abstract: A presumed optimal LV-Ps between 2 and 5 o'clock in the short-axis circumference and basal or mid-ventricular in the long axis is not associated with a lower mortality or a better clinical response in patients treated with CRT.

Cited by 33 publications

References 21 publications

Long‐Term Outcomes of Cardiac Resynchronization Therapy Using Apical Versus Nonapical Left Ventricular Pacing

Long‐Term Outcomes of Cardiac Resynchronization Therapy Using Apical Versus Nonapical Left Ventricular Pacing

Predictors for Cardiac Resynchronization Therapy Response

Current and future role of cardiovascular magnetic resonance in cardiac resynchronization therapy

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