Document Detail

Left ventricular lead position and clinical outcome in the multicenter automatic defibrillator implantation trial-cardiac resynchronization therapy (MADIT-CRT) trial.
MedLine Citation:
PMID:  21382893     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: An important determinant of successful cardiac resynchronization therapy for heart failure is the position of the left ventricular (LV) pacing lead. The aim of this study was to analyze the impact of the LV lead position on outcome in patients randomized to cardiac resynchronization-defibrillation in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) study.
METHODS AND RESULTS: The location of the LV lead was assessed by means of coronary venograms and chest x-rays recorded at the time of device implantation. The LV lead location was classified along the short axis into an anterior, lateral, or posterior position and along the long axis into a basal, midventricular, or apical region. The primary end point of MADIT-CRT was heart failure (HF) hospitalization or death, whichever came first. The LV lead position was assessed in 799 patients, (55% patients ≥65 years of age, 26% female, 10% LV ejection fraction ≤25%, 55% ischemic cardiomyopathy, and 71% left bundle-branch block) with a follow-up of 29±11 months. The extent of cardiac resynchronization therapy benefit was similar for leads in the anterior, lateral, or posterior position (P=0.652). The apical lead location compared with leads located in the nonapical position (basal or midventricular region) was associated with a significantly increased risk for heart failure/death (hazard ratio=1.72; 95% confidence interval, 1.09 to 2.71; P=0.019) after adjustment for the clinical covariates. The apical lead position was also associated with an increased risk for death (hazard ratio=2.91; 95% confidence interval, 1.42 to 5.97; P=0.004).
CONCLUSION: LV leads positioned in the apical region were associated with an unfavorable outcome, suggesting that this lead location should be avoided in cardiac resynchronization therapy. Clinical Trial Registration- URL: Unique identifier: NCT00180271.
Jagmeet P Singh; Helmut U Klein; David T Huang; Sven Reek; Malte Kuniss; Aurelio Quesada; Alon Barsheshet; David Cannom; Ilan Goldenberg; Scott McNitt; James P Daubert; Wojciech Zareba; Arthur J Moss
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2011-03-07
Journal Detail:
Title:  Circulation     Volume:  123     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-22     Completed Date:  2011-05-23     Revised Date:  2011-06-08    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1159-66     Citation Subset:  AIM; IM    
DPhil, GRB 109, Cardiac Arrhythmia Service, Massachusetts General Hospital Heart Center, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
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MeSH Terms
Cardiac Resynchronization Therapy*
Defibrillators, Implantable*
Electrodes, Implanted*
Heart Failure / therapy*
Heart Ventricles
Middle Aged
Prospective Studies
Ventricular Function, Left
Comment In:
Nat Rev Cardiol. 2011 May;8(5):243   [PMID:  21451472 ]

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