Key result
Larger LV-RV interlead distance on lateral fluoroscopy is associated with a more favorable 6-month response to cardiac resynchronization therapy (18.1 vs 14.8 cm, P=0.011).
Why the study?
Does a larger interlead distance improve immediate and mid-term response to cardiac resynchronization therapy in patients with standard CRT indications?
Observational (n=35)
Does a larger interlead distance improve immediate and mid-term response to cardiac resynchronization therapy in patients with standard CRT indications?
p-value: p=0.011
A larger interlead distance on lateral fluoroscopy is associated with more favorable immediate and mid-term response to cardiac resynchronization therapy.
Larger interlead distance may predict CRT response; hypothesis-generating and should not change practice without prospective trials.
OBJECTIVES: It is currently recommended that the left ventricular (LV) lead be placed at the posterolateral or lateral wall of heart during cardiac resynchronization therapy (CRT). The aim of our study is to evaluate the influence of interlead distance on immediate and mid-term response to CRT with altered right ventricular (RV) pacing site. DESIGN: A total of 35 consecutive patients underwent CRT for standard indications. RV pacing site was altered from RV outflow tract (RVOT) to RV apex (RVA) in the course of implantation, permitting assessment of a "poorer response" and a "better response" site based on intraprocedural aortic velocity time integral (aVTI). LV-RV interlead distances were compared between these sites during operation. We also made a comparison of the interlead distances between responders and non-responders 6 months after CRT. RESULTS: In the process of CRT implantation, the better response site showed significantly larger interlead distance (16.5 ± 4.4 cm vs.12.4 ± 5.6 cm, p = 0.001) as well as its vertical component (9.8 ± 4.8 cm vs. 4.3 ± 2.8 mm, p = 0.001) on lateral fluoroscopy view as compared with the poorer response site. Furthermore, RVA proved more likely to be the "better response" site than RVOT (91% vs. 9%, p = 0.001). At 6-month -up, responders demonstrated larger direct interlead distance (18.1 ± 4.5 cm vs. 14.8 ± 3.5 cm, p = 0.011) and horizontal interlead distance (14.1 ± 6.6 cm vs. 8.3 ± 6.1 cm, p = 0.004) on the lateral radiograph in comparison with non-responders with great significance. CONCLUSIONS: Larger interlead distance on lateral fluoroscopy view is associated with more favorable immediate and mid-term response to CRT. Use of these findings may help to maximize the benefit derived from CRT.
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Wang et al. (2013) conducted an observational in Heart failure requiring cardiac resynchronization therapy (n=35). Larger LV-RV interlead distance vs. Shorter LV-RV interlead distance was evaluated on Response to cardiac resynchronization therapy at 6 months (p=0.011). Larger LV-RV interlead distance on lateral fluoroscopy is associated with a more favorable 6-month response to cardiac resynchronization therapy (18.1 vs 14.8 cm, P=0.011).
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