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April 18, 2016European Journal of Heart FailureOpen Access

Multimodality Imaging-Guided Left Ventricular Lead Placement in Cardiac Resynchronization Therapy: A Randomized Controlled Trial

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Why the study?

Does multimodality imaging-guided LV lead placement reduce clinical non-response in patients undergoing cardiac resynchronization therapy?

Population

182 patients undergoing cardiac resynchronization therapy (CRT)

Comparison

Multimodality imaging-guided left ventricular… vs Routine LV lead implantation in a posterolateral…

Design

RCT, randomized, double-blind

Follow-up

6 months; 1.8 ± 0.9 years

Authors

ASA SommerElectrophysiologyMKMads Brix KronborgElectrophysiologyBNBjarne Linde NørgaardCardiac Imaging

Discussion

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Implication

May warrant multimodality imaging for LV lead placement in CRT; extends observational data with RCT evidence.

Structured PICO

Does multimodality imaging-guided LV lead placement reduce clinical non-response in patients undergoing cardiac resynchronization therapy?

P
Population
182 patients undergoing cardiac resynchronization therapy (CRT)
I
Intervention
Multimodality imaging-guided left ventricular (LV) lead placement using Technetium myocardial perfusion imaging and speckle-tracking echocardiography radial strain to target the optimal coronary sinus branch closest to the non-scarred myocardial segment with latest mechanical activation
C
Comparator
Routine LV lead implantation in a posterolateral region with late electrical activation
O
Outcome
Clinical non-response to CRT [≥1 of the following after 6 months: (1) death, (2) heart failure hospitalization, or (3) no improvement in New York Heart Association class and <10% increase in 6-min walk distance]composite

Multimodality imaging-guided LV lead placement to target the latest mechanically activated non-scarred segment reduces clinical non-response to CRT at 6 months.

Limitations

  • Requires larger long-term multicentre studies

Cite This Study

Sommer et al. (2016) studied this question.

synapsesocial.com/papers/6a760beb0a26ee97d494acb2https://doi.org/10.1002/ejhf.530

Topics

Heart failure hospitalizationEchocardiographyHFrEF treatmentHeart failure
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Cardiac-Resynchronization Therapy for the Prevention of Heart-Failure Events2009 · 3,175 citations
  2. 2Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy2012 · 654 citations
  3. 3Relative Merits of Left Ventricular Dyssynchrony, Left Ventricular Lead Position, and Myocardial Scar to Predict Long-Term Survival of Ischemic Heart Failure Patients Undergoing Cardiac Resynchronization Therapy2010 · 291 citations
  4. 4The relationship between ventricular electrical delay and left ventricular remodelling with cardiac resynchronization therapy2011 · 347 citations
  5. 5Cardiac Resynchronization in Chronic Heart Failure2002 · 4,614 citations