Optimizing implantation of cardiac resynchronization therapy: a randomized controlled trial of electrophysiological or anatomical left ventricular lead placement strategy

There is a variety of cardiac resynchronization therapy (CRT) strategies and none has ultimate benefits over the others. Aim. To evaluate the influence of two strategies of left ventricular (LV) electrode implantation on the development of cardiovascular events in patients with chronic cardiac failure. Material and methods . This was a randomized controlled clinical trial designed to compare the effectiveness of traditional anatomy-guided LV lead positioning strategy towards the electrocardiography-guided implantation approach in an optimal branch of the coronary sinus vein, being the closest to the latest electrically activated myocardial region. Results. We enrolled 63 patients with NYHA class III or IV chronic heart failure with ventricular dyssynchrony, an LV ejection fraction (LVEF) less than 35%, an LV end diastolic dimension exceeding 150 ml, a QRS interval over 130 ms. The survival time in electrocardiography-guided approach (study group) was equal to 11,22 months, which was significantly lower in the anatomy-guided approach (control group). Time to re-hospitalization in a study group was nearly two times longer as compared with that in patients from the control group (10,188 months versus 5,548 months). LVEF was significantly higher in the study group with median value equal to 39% versus that in the control group equal to 35% (р=0,002). Conclusions. The results of the present study demonstrate that electrocardiographyguided approach has benefits over traditional anatomy-guided approach in terms of improved cardiac structure and function in patients with NYHA class III and IV heart failure associated with ventricular dyssynchrony.