| Mortality and morbidity in cardiac resynchronization patients: impact of lead position, paced left ventricular QRS morphology and other characteristics on long-term outcome. | |
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MedLine Citation:
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PMID: 23047489 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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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. |
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Authors:
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Marek Jastrzebski; Jerzy Wilinski; Kamil Fijorek; Tomasz Sondej; Danuta Czarnecka |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-10-9 |
Journal Detail:
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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:
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Created Date: 2012-10-10 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 100883649 Medline TA: Europace Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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First Department of Cardiology and Hypertension, University Hospital, ul. Kopernika 17, 31-501 Cracow, Poland. |
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