The left ventricular lead electrical delay predicts response to cardiac resynchronisation therapy

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Cardiac resynchronisation therapy (CRT) is a treatment for heart failure, but up to one-third of patients do not respond.
• Identifying potential CRT responders is often difficult and time-consuming, impacting treatment efficacy.
• Predicting CRT response is crucial for optimizing patient outcomes and resource allocation.

Purpose of the Study:

• To evaluate the predictive value of electrical left ventricular (LV) lead characteristics for CRT response.
• To determine if electrical left ventricular lead delay (LVLED) can predict echocardiographic response to CRT.
• To assess the relationship between anatomic LV pacing site and CRT response.

Main Methods:

• Forty-five patients undergoing CRT implantation were assessed.
• Electrical LV lead location was evaluated using LV activation time (LVAT), LVLED, and RV-LV interlead electrical delay.
• Anatomic LV pacing sites were categorized as traditionally optimal or non-optimal.
• CRT response was defined as >15% decrease in LV end-systolic volume (LVESV) at six months.

Main Results:

• LVLED was significantly larger in responders (67.3 ± 8.5%) compared to non-responders (55.3 ± 8.1%).
• LVLED and complete left bundle branch block (CLBBB) morphology were independent predictors of CRT response.
• A LVLED cutoff of >54.82% predicted responders with 96.3% sensitivity and 75.2% specificity (AUC=0.844).
• No significant relationship was found between anatomic LV pacing sites and CRT response.

Conclusions:

• Increased left ventricular lead electrical delay (LVLED) is a strong predictor of positive echocardiographic response to CRT.
• LVLED, alongside CLBBB morphology, can aid in selecting patients likely to benefit from CRT.
• Electrical lead characteristics, specifically LVLED, are more predictive of CRT response than anatomic lead placement.