Right ventricular apical pacing and high posterior septal pacing in CRT resulted in similar rates of LV reverse remodelling (65% vs. 64%; P=0.93) at 6-month follow-up.
RCT (n=85)
randomized
Does right ventricular high posterior septal lead position improve LV reverse remodelling compared to right ventricular apical lead position in patients undergoing CRT?
In patients undergoing CRT, right ventricular high posterior septal pacing does not provide superior LV reverse remodelling or resynchronization compared to traditional right ventricular apical pacing.
Absolute Event Rate: 65% vs 64%
p-value: p=0.93
Abstract Aims The effect on left ventricular (LV) systolic function and LV dyssynchrony by alternative right ventricular (RV) lead position in cardiac resynchronization therapy (CRT) is unclear. In the present study, RV apical (RV-A) was compared with RV high posterior septal (RV-HS) lead position in CRT. Methods and results In 85 consecutive CRT patients (mean age 66 ±11 years) the RV lead placement was randomized to RV-A (n = 43) or RV-HS (n = 42). The LV lead was targeted to the latest activated LV segment (concordant LV lead), identified by two-dimensional speckle tracking radial strain (ST-RS) echocardiography. Concordant LV leads were obtained in 72%, similar in RV-A and RV-HS (79% vs. 64%; P = 0.13). Six months after CRT, no difference was found in LV reverse remodelling (reduction of LV end-systolic volume ≥15%) according to RV-A and RV-HS leads 26 (65%) vs. 25 (64%); P = 0.93. Superior LV reverse remodelling was observed in concordant LV leads compared with discordant LV leads 41 (73%) vs. 10 (43%); P = 0.01. At 6-month follow-up, LV reverse dyssynchrony (reduction of anteroseptal to posterior delay ≥50%) using ST-RS imaging was similar in RV-A and RV-HS 25 (63%) vs. 24 (62%); P = 0.93. More LV reverse dyssynchrony was found in concordant LV leads vs. discordant LV leads 39 (70%) vs. 10 (43%); P = 0.03. A concordant LV lead was an independent predictor of LV reverse remodelling (odds ratio, 3.65; P = 0.01) and LV reverse dyssynchrony (odds ratio, 4.22; P = 0.02) 6 months after CRT. Conclusion RV-A and RV-HS in CRT demonstrated similar LV reverse remodelling and LV reverse dyssynchrony at 6-month follow-up. Concordant LV leads provided superior LV reverse remodelling and LV reverse dyssynchrony. Trial registration: NCT01035489
Kristiansen et al. (Fri,) conducted a rct in Cardiac resynchronization therapy (CRT) (n=85). Right ventricular apical (RV-A) pacing vs. Right ventricular high posterior septal (RV-HS) pacing was evaluated on LV reverse remodelling (reduction of LV end-systolic volume ≥15%) (p=0.93). Right ventricular apical pacing and high posterior septal pacing in CRT resulted in similar rates of LV reverse remodelling (65% vs. 64%; P=0.93) at 6-month follow-up.