Sites of left and right ventricular lead implantation and response to cardiac resynchronization therapy observations from the REVERSE trial

Thébault, Christophe; Donal, Erwan; Meunier, Catherine; Gervais, Renaud; Gerritse, Bart; Gold, Michael R.; Abraham, William T.; Linde, Cecilia; Daubert, J.-C.

doi:10.1093/eurheartj/ehr505

Cited by 161 publications

(136 citation statements)

References 33 publications

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“…The cause and mode of death were not considered in either MADIT‐CRT2 or REVERSE 3. Our finding of lower cardiac mortality as well as death from pump failure with an apical LV lead position is in keeping with experimental and clinical studies showing that LV apical pacing is physiologically superior to nonapical pacing 4, 5…”

Section: Discussionsupporting

confidence: 66%

“…A subanalysis of the MADIT‐CRT (Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy) trial, apical LV lead positions were less favorable than basal or mid‐LV lead positions in terms of total mortality and HF hospitalization 2. Similar findings emerged from a subanalysis of the REVERSE (Resynchronization Reverses Remodeling in Systolic Left Ventricular Dysfunction) trial 3. These findings are counterintuitive, as previous experimental and clinical evidence shows that an apical LV lead position is more favorable than nonapical positions 4, 5.…”

Section: Introductionmentioning

confidence: 63%

“…Importantly, however, hard end points were not addressed, given unacceptable study heterogeneity. In the REVERSE trial, no differences in a composite clinical score were observed between RV apical and nonapical lead positions 3. In the SEPTAL‐CRT (SEPTAL‐cardiac resynchronization therapy) study,19 the LV reverse remodeling response as well as total mortality or HF hospitalization were similar with RV apical and nonapical lead positions.…”

Section: Discussionmentioning

confidence: 97%

“…In the REVERSE trial,3 comprising a subset of 346 patients and a follow‐up of 1.05 years, an LV nonapical lead position was associated a lower risk of total mortality or HF hospitalization compared with an LV apical position (HR 0.27). We should consider, however, that in the subanalyses of these randomized controlled trials, outcomes were reported in relation to other CRT patients with other LV lead positions.…”

Section: Discussionmentioning

confidence: 99%

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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: 66%

Section: Introductionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

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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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“…Subanalysis of MADIT‐CRT21 demonstrated that the apical position of left ventricular lead was associated with worse outcome. Similar result was confirmed in the subanalysis of REVERSE trial 22. To reduce the number of patients who do not respond for CRT, the operator should avoid apical LV lead position as possible.…”

Section: How To Reduce Nonresponder? Importance Of Appropriate LV Pacsupporting

confidence: 74%

Up‐to‐date cardiac resynchronization therapy

Okamura

2017

J of Gen and Family Med

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Cardiac resynchronization therapy (CRT) has been first reported more than 10 years ago as a therapy for patients with severe chronic heart failure. The efficacy of CRT has been proven in many studies that it improves not only quality of life but also the prognosis of the patients. Its indication has been expanded for patients with mild heart failure. On the other hand, some patients cannot receive enough benefit through CRT. The position of the left ventricular lead is limited due to the anatomy of coronary sinus branches, pacing threshold of the myocardium, phrenic nerve stimulation, and so on. Also, the right selection of the candidates for CRT is critical to receive the most benefit of this therapy. The target of this review article is to describe the efficacy and the indication of CRT, which can be of any help to enroll more patients with heart failure who are likely to get benefits through CRT.

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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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Sites of left and right ventricular lead implantation and response to cardiac resynchronization therapy observations from the REVERSE trial

Cited by 161 publications

References 33 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

Up‐to‐date cardiac resynchronization therapy

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

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