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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
12:45

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

Impact of interventricular lead distance and the decrease in septal-to-lateral delay on response to cardiac

Sandra Buck1, Alexander H Maass, Wybe Nieuwland

  • 1Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, RB Groningen, The Netherlands.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|August 13, 2008
PubMed

Insights

Optimizing cardiac resynchronization therapy (CRT) success involves lead placement. A larger interlead distance and reduced septal-to-lateral delay predict positive CRT response in heart failure patients.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Heart Failure Management

Background:

  • Cardiac resynchronization therapy (CRT) is crucial for advanced chronic heart failure with electrical dyssynchrony.
  • Despite established criteria, 20-40% of patients do not respond to CRT, necessitating further optimization strategies.

Purpose of the Study:

  • To investigate how interlead distance and lead positioning influence CRT success.
  • To identify predictors of CRT response in patients with heart failure and dyssynchrony.

Main Methods:

  • Retrospective analysis of 174 CRT-implanted patients, defining response as a >=10% decrease in left ventricular end-systolic volume after 6 months.
  • Univariate and multivariate logistic regression analyses were used to identify predictors of CRT response.

Main Results:

  • Responders (55%) showed a significantly larger horizontal interlead distance (OR 2.8) and greater septal-to-lateral delay reduction (62 vs. 26 ms).
  • Other predictors included non-ischaemic cardiomyopathy, smaller LV end-diastolic diameter, ACE inhibitor use, and no tricuspid insufficiency.
  • A septal-to-lateral delay >60 ms was a strong predictor of response (OR 4.9).

Conclusions:

  • A larger interlead distance, often indicating posterior left ventricular lead placement, is associated with CRT response.
  • Diminishing intraventricular delay, specifically septal-to-lateral delay, is a key predictor of successful CRT outcomes.
Abstract

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