An anterior left ventricular lead position is associated with increased mortality and non-response in cardiac resynchronization therapy

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• 作者：Mads Brix Kronborg^a ; ^{Mads.Brix.Kronborg@ki.au.dk" class="auth_mail" title="E-mail the corresponding author} ; Jens Brock Johansen^b ; Sam Riahi^c ; Helen Hoegh Petersen^d ; Jens Haarbo^e ; Ole Dan Jø ; rgensen^f ; Jens Cosedis Nielsen^a
• 关键词：Cardiac resynchronization therapy ; Pacing ; Lead position ; Heart failure ; Biventricular pacing
• 刊名：International Journal of Cardiology
• 出版年：2016
• 出版时间：1 November 2016
• 年：2016
• 卷：222
• 期：Complete
• 页码：157-162
• 全文大小：522 K

文摘

Non-response to cardiac resynchronization therapy (CRT) might be due to insufficient resynchronization as a result of a sub-optimal left ventricular lead positon (LV-LP).

Objective

To evaluate the impact of different LV-LPs on mortality and symptomatic improvement in a large cohort of patients treated with CRT.

Methods

We performed a nationwide cohort study on consecutive patients receiving a CRT device from 1997 to 2012 registered in the Danish pacemaker and ICD register. The LV-LP was defined clockwise in a left anterior oblique (LAO) view and categorized as anterior (≤ 2 o'clock), lateral (2 to 4 o'clock) or posterior (> 4 o'clock), and as basal, mid-ventricular, or apical in a right anterior oblique (RAO) view. Outcomes were all cause mortality and clinical response (improvement in NYHA class). Adjusted hazard ratio (aHR) and odds ratio (aOR) with 95% confidence intervals (CI) were calculated using Cox and logistic regression analysis.

Results

A total of 2594 patients were included. A lateral LV-LP, (aHR 0.77, 95% CI 0.64–0.92, p = 0.004), and a posterior LV-LP, (aHR 0.71 95% CI 0.53–0.97, p = 0.029) were associated with lower mortality as compared to an anterior LV-LP. A lateral LV-PV was associated with higher clinical response rate as compared to an anterior LV-LP (aOR 1.37, 1.03–1.83, p = 0.032). No statistically significant associations were observed between LV-LP in the RAO view and mortality or clinical response.

Conclusion

An anterior left ventricular lead position is associated with increased all-cause mortality and lower clinical response rate in patients treated with CRT and should be avoided.