Key result
Anterior or anterolateral LV lead placement is non-inferior to lateral wall positioning for 6-month CRT response.
Why the study?
Does anterior or anterolateral left ventricular lead placement maintain clinical response compared to lateral or posterolateral placement in patients receiving cardiac resynchronization therapy?
Cohort (n=77)
Does anterior or anterolateral left ventricular lead placement maintain clinical response compared to lateral or posterolateral placement in patients receiving cardiac resynchronization therapy?
Positioning the left ventricular lead in an anterior or anterolateral location is a reasonable and non-inferior alternative when lateral or posterolateral implantation fails during CRT.
Answers are grounded in this paper and cite their sources.
May support anterior/anterolateral LV lead placement as alternative when lateral sites inaccessible in CRT; leaves open need for randomized confirmation.
BACKGROUND: The recommended left ventricular (LV) lead position for cardiac resynchronization therapy (CRT) is at the lateral or posterolateral wall. However, LV leads cannot always be implanted at this site. The objective of our study was to compare the clinical response to CRT when the LV lead could be implanted or not at the lateral or posterolateral wall. METHODS: In consecutive patients implanted with a CRT device, we documented the final position achieved by the tip of the LV lead in the left anterior oblique projection. Patients were prospectively followed for 6 months after implantation. They were defined as responders if they were alive, had gained 1 New York Heart Association (NYHA) functional class, and had not been hospitalized for heart failure. RESULTS: The study population consisted of 77 patients (56 men, 71 +/- 10 years, 62 NYHA class III, 15 NYHA class IV). The LV lead was implanted at the lateral or posterolateral wall in 54 patients (group A) and at the anterior or anterolateral wall in 23 patients (group B). At 6 months, seven patients (9%) died (all in group A). There were 37 responders (69%) in group A as compared to 22 (96%) in group B. CONCLUSIONS: The responder rate was not inferior when the LV lead was implanted at the anterior or anterolateral wall. Thus, in case of failed implantation at the lateral or posterolateral wall, positioning the LV lead in a more anterior location appears to be a reasonable alternative. Further studies are required to confirm these findings.
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d'Ivernois et al. (2008) conducted a cohort in Heart failure requiring cardiac resynchronization therapy (n=77). LV lead implanted at the anterior or anterolateral wall vs. LV lead implanted at the lateral or posterolateral wall was evaluated on Clinical response (alive, gained 1 NYHA functional class, and not hospitalized for heart failure). Positioning the LV lead at the anterior or anterolateral wall was not inferior to the lateral or posterolateral wall for CRT response (96% vs 69% at 6 months).
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