40Lateral left ventricular lead position and long interlead electrical delay predict long-term all-cause mortality in cardiac resynchronization therapy patients

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Behon ◽  
W R Schwertner ◽  
E D Merkel ◽  
A Kovacs ◽  
V Kutyifa ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Primary Endpoint ◽  
Lateral Position ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Ventricular Lead ◽  
All Cause Mortality ◽  
Lead Location

Abstract Background There is limited data on the association of left ventricular (LV) lead position and long-term clinical outcome in patients after cardiac resynchronization therapy (CRT). Purpose We evaluated the mid-term echocardiographic response and long-term all-cause mortality of patients who underwent CRT implantation by LV lead non-apical positions and further characterized them by right to left ventricular, interlead electrical delay (IED). Methods In our retrospective registry patients after CRT implantation between 2000 and 2018 were registered. Those with non-apical LV lead location were classified into anterior (n = 111), posterior (n = 652), and lateral (n = 1373) positions. Primary endpoint was all-cause mortality assessed by univariate- and Cox multivariate analyses. Secondary endpoint was echocardiographic response within 6 months after CRT implantation. Results From 2136 patients 1180 (55.2%) reached the primary endpoint during the mean follow up time of 4.5 years. Univariate analysis showed patients with lateral position had significantly better outcome compared to others (HR 0.80; 95% CI: 0.71-0.90; p < 0.01), which was also confirmed by Cox multivariate analysis (HR 0.69; 95% CI: 0.50-0.93; p = 0.02) after adjusting for relevant clinical covariates such as IED and LBBB. The median value of IED was 106 (89/124) ms in the total patient cohort, which was significantly longer in the lateral group [anterior 80 (60/100) ms vs. lateral 110 (91/128) ms vs. posterior 100 (85/120) ms; p< 0.01]. When echocardiographic response was further evaluated in patients with lateral position, those with an IED longer than 110 ms (ROC AUC 0.64, 95% CI: 0.54-0.74; p = 0.01) showed the greatest benefit within 6 months. Conclusions After CRT implantation the most beneficial outcome was associated with lateral left ventricular lead location, moreover the greatest echocardiographic response was found when interlead electrical delay was longer than 110 ms in this group. Abstract Figure. All-cause mortality of total cohort

scholarly journals Left Ventricular Lead Location and Long-Term Outcomes in Cardiac Resynchronization Therapy Patients

2018 ◽  
Vol 4 (11) ◽  
pp. 1410-1420 ◽  
Author(s):  
Valentina Kutyifa ◽  
Annamaria Kosztin ◽  
Helmut U. Klein ◽  
Yitschak Biton ◽  
Vivien Klaudia Nagy ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Left Ventricular Lead ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Long Term Outcomes ◽  
Ventricular Lead ◽  
Lead Location

scholarly journals Lateral left ventricular lead position is superior to posterior position in long-term outcome of patients underwent cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Behon ◽  
W.R Schwertner ◽  
E.D Merkel ◽  
A Kovacs ◽  
B.K Lakatos ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Lead Position ◽  
Ventricular Lead ◽  
All Cause Mortality

Abstract Background Preferring side branch of coronary sinus during cardiac resynchronization therapy (CRT) implantation is empirical due to the limited data on the association of left ventricular (LV) lead position and long-term clinical outcome. Purpose We evaluated the long-term all-cause mortality by LV lead non-apical positions and further characterized them by interlead electrical delay (IED). Methods In our retrospective database 2087 patients were registered between 2000 and 2018. Those with non-apical LV lead locations were classified into anterior (n=108), posterior (n=643), and lateral (n=1336) groups. All-cause mortality was assessed by Kaplan-Meier and Cox analyses. Echocardiographic response was measured 6 months after CRT implantation. Results During the median follow-up time of 3.7 years, 1150 (55.1%) patients died, 710 (53.1%) with lateral, 78 (72.2%) with anterior and 362 (56.3%) with posterior positions. Patients with lateral position had significantly better outcome in all-cause mortality compared to others (HR 0.80; 95% CI: 0.71–0.90; p<0.0001), which was also confirmed by multivariate analysis after adjusting for relevant clinical covariates (HR 0.81; 95% CI: 0.72–0.91; p<0.0001). When echocardiographic response was evaluated in the lateral group, patients with an IED longer than 110 ms (ROC AUC 0.63; 95% CI: 0.53–0.73; p=0.012) showed 2.1 times higher odds of improvement in echocardiographic response 6 months after the implantation. Conclusions In this study we proved that after CRT implantation only the lateral LV lead location was associated with long-term mortality benefit. Moreover, patients with this position showed the greatest echocardiographic response over 110 ms IED. Survival of total patient cohort Funding Acknowledgement Type of funding source: None

Incremental prognostic value of combining left ventricular lead position and systolic dyssynchrony in predicting long-term survival after cardiac resynchronization therapy

2009 ◽  
Vol 117 (11) ◽  
pp. 397-404 ◽  
Author(s):  
Qing Zhang ◽  
Gabriel W.-K. Yip ◽  
Yat-Sun Chan ◽  
Jeffrey W.-H. Fung ◽  
Winnie Chan ◽  
...  
Keyword(s):  
Cardiovascular Mortality ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Lead Position ◽  
Left Ventricular Lead Position ◽  
Ventricular Lead ◽  
All Cause Mortality ◽  
Additional Value

The efficacy of CRT (cardiac resynchronization therapy) can be affected by a number of factors; however, the prognostic significance of the LV (left ventricular) lead position has not been explored. The aim of the present study was to examine whether a PL (posterolateral) lead position has an additional value to systolic dyssynchrony in predicting a better survival after CRT. Patients (n=134) who received CRT were followed-up for 39±24 months. The LV lead position was determined by cine fluoroscopy, and baseline dyssynchrony was assessed by TDI (tissue Doppler imaging). The relationship between the LV lead position/dyssynchrony and mortality was compared using Kaplan–Meier curves, followed by Cox regression analysis. The all-cause and cardiovascular mortalities were 38 and 31% respectively. The presence of dyssynchrony and a PL lead position predicted a lower all-cause mortality (29 compared with 47%; log-rank χ2=5.38, P=0.02) and cardiovascular mortality (21 compared with 41%; log-rank χ2=6.75, P=0.009) than when absent. The all-cause mortality was as high as 62% when patients had neither dyssynchrony nor a PL lead position, but was reduced to 29% when both criteria were present, and was between 45 and 46% when only one criterion was present (χ2=6.79, P=0.01). The corresponding values for cardiovascular mortality were 62% when patients had neither dyssynchrony nor a PL lead position, 36–38% when patients had either dyssynchrony or a PL lead position, and 21% when patients had both criteria present (χ2=9.54, P=0.004). Combining dyssynchrony and a PL lead position independently predicted a lower all-cause morality {HR (hazard ratio), 0.496 [95% CI (confidence interval), 0.278–0.888]; P=0.018} and cardiovascular mortality [HR, 0.442 (95% CI, 0.232–0.844); P=0.013]. In conclusion, the placement of the LV lead at a PL position provides additional value to baseline dyssynchrony in predicting a lower all-cause and cardiovascular mortality during long-term follow-up after CRT.

Upgrade from implantable cardioverter-defibrillator vs. de novo implantation of cardiac resynchronization therapy: long-term outcomes

EP Europace ◽  
2020 ◽  
Author(s):  
Ewa Jędrzejczyk-Patej ◽  
Michał Mazurek ◽  
Agnieszka Kotalczyk ◽  
Wiktoria Kowalska ◽  
Aleksandra Konieczny-Kozielska ◽  
...  
Keyword(s):  
Cardiac Resynchronization Therapy ◽  
Implantable Cardioverter Defibrillator ◽  
De Novo ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Urban Region ◽  
Resynchronization Therapy ◽  
Cardioverter Defibrillator ◽  
All Cause Mortality

Abstract Aims  To assess and compare long-term mortality and predictors thereof in de novo cardiac resynchronization therapy defibrillators (CRT-D) vs. upgrade from an implantable cardioverter-defibrillator (ICD) to CRT-D. Methods and results  Study population consisted of 595 consecutive patients with CRT-D implanted between 2002 and 2015 in a tertiary care, university hospital, in a densely inhabited, urban region of Poland [480 subjects (84.3%) with CRT-D de novo implantation; 115 patients (15.7%) upgraded from ICD to CRT-D]. In a median observation of 1692 days (range 457–3067), all-cause mortality for de novo CRT-D vs. CRT-D upgrade was 35.5% vs. 43.5%, respectively (P = 0.045). On multivariable regression analysis including all CRT recipients, the previously implanted ICD was an independent predictor for death [hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.10–2.29, P = 0.02]. For those, who were upgraded from ICD to CRT-D, the independent predictors for all-cause death were as follows: creatinine level (HR 1.01, 95% CI 1.00–1.02, P = 0.01), left ventricular end-systolic diameter (HR 1.07, 95% CI 1.02–1.11, P = 0.002), New York Heart Association (NYHA) IV class at baseline (HR 2.36, 95% CI 1.00–5.53, P = 0.049) and cardiac device-related infective endocarditis during follow-up (HR 2.42, 95% CI 1.02–5.75, P = 0.046). A new CRT scale (Creatinine ≥150 μmol/L; Remodelling, left ventricular end-systolic ≥59 mm; Threshold for NYHA, NYHA = IV) showed high prediction for mortality in CRT-D upgrades (AUC 0.70, 95% CI 0.59–0.80, P = 0.0007). Conclusion  All-cause mortality in patients upgraded from ICD is significantly higher compared with de novo CRT-D implantations and reaches almost 45% within 4.5 years. A new CRT scale (Creatinine; Remodelling; Threshold for NYHA) has been proposed to help survival prediction following CRT upgrade.

Sign in / Sign up

Export Citation Format

Share Document