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Electrical Delay in Apically Positioned Left Ventricular Leads and Clinical Outcome After Cardiac Resynchronization Therapy
- Source :
- Journal of Cardiovascular Electrophysiology. 24:182-187
- Publication Year :
- 2012
- Publisher :
- Wiley, 2012.
-
Abstract
- Electrical Delay in Apically Positioned LV Leads. Introduction: In recent studies, an anatomical apical left ventricular (LV) lead pacing location has been associated with deleterious outcome after cardiac resynchronization therapy (CRT). The differential impact of the LV lead electrical location in these patients remains unknown. Methods and Results: Thirty-one consecutive CRT patients (mean age 71.7 ± 12.7 years, 55% left bundle-branch block [LBBB] morphology) with an apical LV lead and LV lead electrical delay (LVLED) were studied. Anatomical LV lead location was determined via review of coronary venography and chest radiographs. Electrical location was assessed through intraprocedural LVLED measurement. Patients were dichotomized into either “long” LVLED (LVLED ≥ 50% of QRS) or “short” LVLED groups (LVLED < 50%). Patients in the long LVLED group demonstrated significantly greater freedom from a primary composite endpoint of all-cause death, heart failure hospitalization, and cardiac transplantation at 2 years (81% vs 30%, P = 0.007 vs short LVLED patients). Longer LVLED was also associated with more favorable LV remodeling (LV end-systolic volume –41.9 ± 10.3 mL vs –4.3 ± 17.2 mL; P = 0.05), and greater improvement in LV ejection fraction (+9.4 ± 2.9% vs +2.3 ± 7.5%; P = 0.04). Even after multivariate adjustment, LVLED remained an independent predictor of the primary composite endpoint (HR 0.47, P = 0.031). Conclusions: Electrical lead localization, as estimated by LVLED ≥ 50%, is associated with improved long-term clinical outcome and measures of LV remodeling in patients with apical LV leads. Intraprocedural LVLED assessment may provide incremental utility in targeting lead placement even in conventionally unfavorable anatomical segments. (J Cardiovasc Electrophysiol, Vol. 24, pp. 182-187, February 2013)
- Subjects :
- Male
medicine.medical_specialty
Heart Ventricles
medicine.medical_treatment
Venography
Cardiac resynchronization therapy
Cardiac Resynchronization Therapy
Prosthesis Implantation
Ventricular Dysfunction, Left
QRS complex
Physiology (medical)
Internal medicine
medicine
Humans
Lead (electronics)
Aged
Heart Failure
Ejection fraction
medicine.diagnostic_test
business.industry
medicine.disease
Electrodes, Implanted
Transplantation
Treatment Outcome
Heart failure
Cardiology
Female
Cardiology and Cardiovascular Medicine
business
Lead Placement
Subjects
Details
- ISSN :
- 10453873
- Volume :
- 24
- Database :
- OpenAIRE
- Journal :
- Journal of Cardiovascular Electrophysiology
- Accession number :
- edsair.doi.dedup.....2b3ffb4a8912a45ea09452b973f64dc8