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Optimal left ventricular lead position predicts reverse remodeling and survival after cardiac resynchronization therapy.
MedLine Citation:
PMID:  19379458     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Objectives. The aim of the current study was to evaluate echocardiographic parameters after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome in patients with the left ventricular (LV) lead positioned at the site of latest activation (concordant LV lead position) as compared with that seen in patients with a discordant LV lead position. Background. A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT. Methods. The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest x-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. Results. Significant LV reverse remodeling (reduction in LV end-systolic volume from 189+/-83 mL to 134+/-71 mL, P<.001) was noted in the group of patients with a concordant LV lead position (n=153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32+/-16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, P=.004). Conclusions. Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up.
Authors:
David Tepper; Scott Harris; Randy Ip
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Congestive heart failure (Greenwich, Conn.)     Volume:  15     ISSN:  1751-7133     ISO Abbreviation:  -     Publication Date:    2009 Mar-Apr
Date Detail:
Created Date:  2009-04-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9714174     Medline TA:  Congest Heart Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  99     Citation Subset:  IM    
Affiliation:
South Broward Cardiology Consultants, Hollywood, FL, USA.
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