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Updated: Aug 11, 2026
Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
Published on: December 11, 2017
Optimization of right ventricular lead position in cardiac resynchronisation therapy
Lucie Riedlbauchová1, Robert Cihák, Jan Bytesník
1Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeòská 1958/9, 140 21 Praha 4, Prague, Czech Republic.
Background:
The benefit of biventricular pacing (BiV) may be substantially affected by optimal lead placement.
Aim:
To evaluate the importance of right ventricular (RV) lead positioning on clinical outcome of BiV.
Methods And Results:
A total of 99 patients with symptomatic heart failure and implantation of BiV system were included. Position of the left-ventricular (LV) lead was selected based on timing of local endocardial signal within the terminal portion of the QRS complex. RV lead was preferably positioned at the midseptum (n=74, RVS group) where the earliest RV endocardial signal was recorded. A subgroup of patients had RV lead placed in the apex (n=25, RVA group). NYHA class, maximum oxygen-uptake (VO(2)max), LV end-diastolic diameter (LVEDD, mm) and ejection fraction were assessed every third month. A trend towards greater improvement in NYHA class and significant increase in VO(2)max was present in the RVS group. Moreover, a significant decrease in LVEDD (DeltaLVEDD) was observed in the RVS group only (-3.4+/-6.5 mm versus +1.7+/-6.4 mm in RVA group at 12 months, p=0.004). No significant correlation between the degree of DeltaLVEDD and QRS narrowing induced by BiV was found. LVEDD reduction was predominantly present in dilated cardiomyopathy.
Conclusions:
Midseptal positioning of the RV lead appears to promote reverse LV remodelling during cardiac resynchronisation therapy.
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