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Updated: Jul 17, 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
Long-term hemodynamic benefit of biventricular pacing depending on coronary sinus lead position
H Nägele1, S Hashagen, M Azizi
1Gustav-Adolf-Stift, 21465 Reinbek, Germany. Herbert_naegele@yahoo.de
Insights
Optimal cardiac resynchronization therapy (CRT) outcomes depend on coronary sinus (CS) lead placement. Posterior and lateral CS lead positions improve heart function long-term, while anterior positions should be avoided.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) effectiveness may be influenced by coronary sinus (CS) lead positioning.
- Limited data exists on the long-term impact of CS lead position on CRT outcomes.
Purpose of the Study:
- To evaluate the long-term effects of different coronary sinus (CS) lead positions on hemodynamic parameters and clinical outcomes in heart failure patients undergoing CRT.
Main Methods:
- 45 heart failure patients with LBBB and QRS >150 ms received biventricular pacemakers.
- CS leads were placed in posterior (P), lateral (L), or anterior (A) branches.
- Clinical status, echocardiography, BNP, and right heart catheterization were assessed at baseline and 6 months post-implantation.
Main Results:
- Patients with posterior (P) and lateral (L) CS lead positions showed significantly better hemodynamic improvements (arterial pressure, PCWP, pulmonary pressure, cardiac index) and ejection fraction increases compared to the anterior (A) group.
- Brain natriuretic peptide (BNP) levels were reduced more significantly in the P and L groups than in the A group.
- Response rates were higher in the P and L groups (94%) compared to the A group (64%) after 6 months.
Conclusions:
- Chronic CRT demonstrates improved ejection fraction, BNP levels, and hemodynamics primarily with lateral and posterior CS lead positioning.
- Anterior CS lead positions are associated with suboptimal long-term outcomes and should be avoided in CRT.
Background:
Acute studies in cardiac resynchronization therapy (CRT) showed that hemodynamic effects may depend on the coronary sinus (CS) lead position. However, there are no data on the longterm effect of CS lead position.
Methods:
In 45 heart failure patients with left bundle branch block and QRS >150 ms (age 59+/-10 years, 17 dilative cardiomyopathy, 23 ischemic, 5 valvular), biventricular pacemakers were implanted. CS leads were positioned in posterior (P, n=15), lateral (L, n=19) or, if no other option available, anterior (A, n=11) side branches. Before and 6 months after implantation, clinical state, echocardiography, brain natriuretic peptide (BNP) and right heart catheterization were evaluated.
Results:
Baseline parameters were similar between groups. After 6 months, there were 32/34 responders in groups P and L compared to 7/11 responders in group A (94 vs groups P and L: Arterial pressure +8 and +9% vs +2%; PCWP -23 and -15% vs -4%, pulmonary pressure -18 and -12% vs -3% (p<0.01 for A vs P+L); cardiac index +21 and +12% vs +11% (p=0.03 for A vs P). BNP was reduced by 55, 35, and 27% (p=0.05 for A vs P). Ejection fraction increased in P and L by 40 and 41%, respectively, but only by +19% in A (p<0.03 for A vs P+L).
Conclusion:
Chronic CRT improves ejection fraction, BNP and hemodynamic measurements predominantly in patients with lateral and posterior CS lead positions. Anterior lead positions should be avoided.
