Key result
Concordant left ventricular lead placement in CRT recipients was associated with superior LV reverse remodelling at 6 months compared to discordant leads (76% vs 45%; P=0.003).
Why the study?
Does concordant left ventricular lead position improve left ventricular reverse remodelling and mechanical resynchronization in CRT recipients?
Cohort (n=103)
Does concordant left ventricular lead position improve left ventricular reverse remodelling and mechanical resynchronization in CRT recipients?
Odds Ratio: 4.177
Absolute Event Rate: 76% vs 45%
p-value: p=0.003
Targeting the left ventricular lead to the latest activated segment significantly improves left ventricular reverse remodeling and mechanical resynchronization in patients receiving cardiac resynchronization therapy.
Supports targeting latest-activated LV segments in CRT; hypothesis-generating pending randomized confirmation of outcomes.
AIMS: To investigate the influence of left ventricular (LV) lead position on LV dyssynchrony in cardiac resynchronization therapy (CRT). METHODS AND RESULTS: The LV lead was prospectively targeted to the latest activated LV segment (concordant) evaluated by two-dimensional speckle tracking radial strain (ST-RS) echocardiography in 103 CRT recipients (67 ± 12 years). Mechanical dyssynchrony was assessed by anteroseptal-to-posterior (AS-P) delay and interventricular mechanical delay (IVMD). Concordant LV leads were obtained in 72 (70%) patients. Superior LV reverse remodelling (LV-RR; ≥ 15% LV end-systolic volume reduction at 6-month follow-up) was observed in the concordant LV leads compared with the discordant LV leads [51 (76%) vs. 13 (45%); P = 0.003]. Mechanical resynchronization responders (≥ 50% AS-P delay reduction at 6-month follow-up) obtained in the concordant LV leads [44 (66%)] was greater than in the discordant LV leads [10 (34%); P = 0.005]. The discordant LV leads located adjacent to the concordant LV leads (+1 segment; n = 22) and 2 segments apart (+2 segments; n = 9) were evaluated in a subgroup analysis. Mechanical resynchronization responders 6 months after CRT were as follows: in +1 segment [n = 10 (48%)] and in +2 segments (n = 0; P = 0.001). The concordant LV lead was the only independent predictor of LV-RR at 6-month follow-up (odds ratio, 4.177; P = 0.004). Independent predictors of mechanical resynchronization responders were AS-P delay (odds ratio, 1.007; P = 0.032), IVMD (odds ratio, 1.024; P = 0.038), and concordant LV lead (odds ratio, 4.691; P = 0.004). CONCLUSION: Concordant LV leads in CRT provided more responders according to both LV reverse remodelling and mechanical resynchronization.
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Kristiansen et al. (2012) conducted a cohort in Cardiac resynchronization therapy (CRT) recipients (n=103). Concordant left ventricular lead position vs. Discordant left ventricular lead position was evaluated on LV reverse remodelling (≥ 15% LV end-systolic volume reduction at 6-month follow-up) (OR 4.177, p=0.003). Concordant left ventricular lead placement in CRT recipients was associated with superior LV reverse remodelling at 6 months compared to discordant leads (76% vs 45%; P=0.003).
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