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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

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The impact of the right ventricular lead position on response to cardiac resynchronization therapy

Fakhar Z Khan1, Pegah Salahshouri, Rudy Duehmke

  • 1Addenbrooke's Hospital, Cambridge, UK. fzkhan@doctors.org.uk

Pacing and Clinical Electrophysiology : PACE
|January 7, 2011
PubMed

Insights

Cardiac resynchronization therapy (CRT) response depends on left ventricular (LV) lead placement, not right ventricular (RV) lead site. Concordant LV lead positioning significantly improves CRT response rates.

Area of Science:

  • Cardiology
  • Medical Devices
  • Electrophysiology

Background:

  • Left ventricular (LV) lead placement in the latest contracting area (concordant LV lead) improves cardiac resynchronization therapy (CRT) response.
  • The impact of right ventricular (RV) lead position on CRT response remains unclear.

Purpose of the Study:

  • To investigate the relationship between RV and LV lead positions and their effect on CRT response.

Main Methods:

  • 131 CRT patients were analyzed, with RV leads placed in the septum (RVS) or apex (RVA).
  • LV lead position was classified as concordant or discordant based on latest contraction site determined by 2D speckle tracking radial strain imaging.
  • CRT response was defined as a ≥15% reduction in LV end-systolic volume (LVESV) at 6-month follow-up.

Main Results:

  • No significant differences in LVESV reduction or responder rates were observed between RVS and RVA groups (58.2% vs 57.9%, P = 0.97).
  • Concordant LV lead positioning resulted in significantly higher response rates compared to discordant positioning (76.1% vs 36.7%, P < 0.001).
  • RV lead location did not influence outcomes in patients with either concordant or discordant LV leads.

Conclusions:

  • Right ventricular lead position does not affect left ventricular reverse remodeling after CRT.
  • Concordant left ventricular lead placement is a key determinant of successful CRT response.
Abstract

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