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Benefits of Cardiac Resynchronization Therapy in an Asynchronous Heart Failure Model Induced by Left Bundle Branch Ablation and Rapid Pacing
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Influence of left ventricular lead location on outcomes in the COMPANION study

Leslie A Saxon1, Brian Olshansky, Kent Volosin

  • 1Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. saxon@usc.edu

Journal of Cardiovascular Electrophysiology
|March 21, 2009
PubMed

Insights

Cardiac resynchronization therapy (CRT) improves outcomes regardless of left ventricular (LV) lead position. The COMPANION trial found CRT benefits mortality and hospitalization rates, with functional improvements seen across all LV lead locations.

Area of Science:

  • Cardiology
  • Medical Devices
  • Clinical Trials

Background:

  • Limited data exist on cardiac resynchronization therapy (CRT) outcomes based on left ventricular (LV) lead placement.
  • The COMPANION study provides insights into CRT's impact on mortality, hospitalization, and functional status.

Purpose of the Study:

  • To evaluate the effect of LV lead location on mortality and hospitalization in CRT recipients.
  • To assess functional outcomes (Functional Class, Quality-of-Life, 6-minute walk distance) in relation to LV lead position.

Main Methods:

  • Analysis of 1,520 patients from the COMPANION study comparing CRT with optimal medical therapy (OPT).
  • Event-driven outcomes including mortality and hospitalization were analyzed.
  • Functional outcomes were assessed across different LV lead locations.

Main Results:

  • CRT recipients showed improved survival and reduced heart failure hospitalizations compared to OPT, irrespective of LV lead location.
  • Most LV lead locations demonstrated a benefit in reducing all-cause mortality or hospitalization.
  • Significant improvements in 6-minute walk distance, Quality-of-Life, and Functional Class were observed with CRT, independent of LV lead position.

Conclusions:

  • LV lead location is not a primary factor influencing CRT response across multiple outcome measures.
  • While specific locations may offer acute hemodynamic advantages, chronic data suggest anterior, lateral, or posterior LV lead placements yield similar benefits.
  • CRT offers significant benefits to patients regardless of the specific LV lead positioning achieved.
Abstract

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