Key result
A non-apical right ventricular lead position was associated with a reduced risk of appropriate therapy for ventricular tachyarrhythmia compared to an apical position (HR 0.70; 95% CI 0.55-0.87; P=0.002).
Why the study?
Does a non-apical right ventricular lead position reduce the risk of appropriate therapy for ventricular tachyarrhythmia in patients with a CRT-D device compared to an apical position?
Cohort (n=1,643)
Yes
Does a non-apical right ventricular lead position reduce the risk of appropriate therapy for ventricular tachyarrhythmia in patients with a CRT-D device compared to an apical position?
Hazard Ratio: 0.7 (95% CI 0.55–0.87)
p-value: p=0.002
In patients with a CRT-D device, a non-apical right ventricular lead position is associated with a significantly lower risk of appropriate therapy for ventricular tachyarrhythmias compared to an apical position.
Aims: To evaluate the impact of different right and left ventricular lead positions (RV-LP and LV-LP) on the risk of therapy for ventricular tachycardia/ventricular fibrillation in patients with a cardiac resynchronization therapy device (CRT-D). Methods and results: We performed a large nationwide cohort study on patients in Denmark receiving a CRT-D device from 2008 to 2012 from the Danish Pacemaker and implantable cardioverter defibrillator (ICD) registry. Lead positions were registered during the implantation and categorized as anterior/lateral/posterior and basal/mid-ventricular/apical for the LV-LP, and as apical/non-apical for the RV-LP. Appropriate and inappropriate therapies were registered during follow-up via remote monitoring or at device interrogations. Time to event was summarized with Kaplan-Meier plots, and competed risk regression analysis was used to calculate adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Following variables were included in the analysis: gender, age, heart failure aetiology, New York heart association class, left ventricular ejection fraction, QRS duration, indication (secondary or primary prophylactic), RV-LP, LV-LP, and antiarrhythmic therapy. We included 1643 patients [mean age 68 (±10) years, 1343 (83%) men]. After a mean of 2.0 years, 322 (20%) patients received appropriate and 66 (4%) patients received inappropriate therapy. The aHR for appropriate therapy with a non-apical RV-LP was 0.70 95% CI (0.55-0.87, P = 0.002) as compared with an apical. We observed no significant association between appropriate therapy and LV-LP in left anterior oblique or right anterior oblique views or inappropriate therapy between any lead positions. Conclusion: An apical RV-LP is associated with an increased risk of appropriate therapy for ventricular tachyarrhythmia in patients with a CRT-D device.
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Kronborg et al. (2017) conducted a cohort in Cardiac resynchronization therapy (CRT-D) (n=1,643). Non-apical right ventricular lead position vs. Apical right ventricular lead position was evaluated on Appropriate therapy for ventricular tachycardia/ventricular fibrillation (HR 0.70, 95% CI 0.55-0.87, p=0.002). A non-apical right ventricular lead position was associated with a reduced risk of appropriate therapy for ventricular tachyarrhythmia compared to an apical position (HR 0.70; 95% CI 0.55-0.87; P=0.002).
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