Document Detail


Mortality and morbidity in cardiac resynchronization patients: impact of lead position, paced left ventricular QRS morphology and other characteristics on long-term outcome.
MedLine Citation:
PMID:  23047489     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
AIMS: To investigate the effect of implantation-related characteristics, especially lead position and left ventricular (LV)-paced QRS morphology, on long-term mortality and morbidity in cardiac resynchronization therapy (CRT) patients.METHODS AND RESULTS: The study retrospectively analysed 362 consecutive patients who underwent CRT device implantation over a 6 year period. Pre-implantation, LV-only paced, and biventricularly paced 12-lead electrocardiograms were obtained. Left ventricular and right ventricular (RV) lead positions were determined using biplane fluoroscopy and roentgenograms. The Kaplan-Meier method was used to estimate the survival function for all-cause death/hospitalization and cardiovascular death/hospitalization. Univariate and multivariate Cox proportional hazards models were also applied. The mean follow-up time was 24.7 ± 16.9 months. There were 79 deaths (62 cardiovascular) and 99 unplanned hospitalizations (72 cardiovascular). One year and 2 year all-cause mortality rates were 8.5 and 18.0%, respectively. Electrocardiographic and fluoroscopic descriptors of the LV lead position were found to be predictors of mortality/morbidity (as were functional class, heart failure aetiology, hyponatremia, and chronic atrial fibrillation). In particular, the antero-apical pattern of LV-only paced QRS showed a hazard ratio (HR) of 1.8 in univariate and 1.7 in multivariate analysis for predicting all-cause death/hospitalization (P = 0.006). The apical/paraseptal LV lead position showed an HR of 2.1 in univariate and 1.9 in multivariate analysis for predicting cardiovascular death/hospitalization (P = 0.018).CONCLUSION: To achieve better long-term outcomes in CRT patients the antero-apical pattern of LV QRS complexes and apical or paraseptal LV lead position should be avoided.
Authors:
Marek Jastrzebski; Jerzy Wilinski; Kamil Fijorek; Tomasz Sondej; Danuta Czarnecka
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-10-9
Journal Detail:
Title:  Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology     Volume:  -     ISSN:  1532-2092     ISO Abbreviation:  Europace     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-10-10     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100883649     Medline TA:  Europace     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
First Department of Cardiology and Hypertension, University Hospital, ul. Kopernika 17, 31-501 Cracow, Poland.
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