July 26, 2026Journal of the American College of Cardiology376 citations
View Full PaperOptimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization Therapy
Key Result
A concordant left ventricular lead position at the site of latest mechanical activation independently predicted hospitalization-free survival after cardiac resynchronization therapy (HR 0.22; P=0.004).
Key Points
- This study aims to assess the impact of left ventricular lead position on outcomes after cardiac resynchronization therapy.
- Evaluated 244 CRT candidates using speckle tracking radial strain analysis to determine LV lead position.
- Performed echocardiographic evaluations at 6 months post-CRT.
- Conducted long-term follow-up for all-cause mortality and heart failure hospitalizations.
- Concordant LV lead position resulted in significant reverse remodeling with a reduction of LV end-systolic volume to 134 +/- 71 ml (p < 0.001).
- Patients with a concordant lead position had fewer heart failure hospitalizations and deaths during a follow-up of 32 +/- 16 months.
- A concordant LV lead position was an independent predictor of hospitalization-free survival (HR: 0.22, p = 0.004).
Study Design
Type
Cohort (n=244)
PICO
P
Population
244 cardiac resynchronization therapy candidates evaluated for left ventricular lead position and followed for a mean of 32 months.
E
Exposure / Comparator
Concordant left ventricular lead position vs Discordant left ventricular lead position
O
Primary Outcome
Hospitalization-free survival (combined heart failure hospitalizations and death) — HR 0.22, p=0.004
Main Result
Hazard Ratio: 0.22
p-value: p=0.004
Abstract
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 < 0.001) 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 = 0.004). 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.