Bipolar left ventricular pacing is associated with significant reduction in heart failure or death in CRT-D patients
Sina Jamé1, Valentina Kutyifa2, Mehmet K Aktas2
1Stanford University, Stanford, California.
Insights
True Bipolar left ventricular lead pacing significantly reduces mortality and heart failure events in patients with left bundle branch block receiving cardiac resynchronization therapy with a defibrillator. This finding offers crucial insights for optimizing CRT-D device programming.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Outcomes
Background:
- Limited data exist on the predictive value of left ventricular (LV) lead pacing polarity for clinical outcomes.
- Understanding these associations is crucial for optimizing cardiac resynchronization therapy (CRT) device performance.
Purpose of the Study:
- To determine if LV lead pacing polarity influences heart failure (HF) or death risk.
- To assess the association between LV pacing polarity and ventricular tachyarrhythmias (VTA) in CRT-D patients.
Main Methods:
- Retrospective analysis of LV pacing polarity in 969 patients from the MADIT-CRT trial.
- Categorization into True Bipolar (LV ring/tip) and Unipolar/Extended Bipolar pacing configurations.
- Kaplan-Meier analysis and Cox regression models to evaluate outcomes.
Main Results:
- True Bipolar pacing was observed in 421 patients; Unipolar/Extended Bipolar in 548.
- In patients with left bundle branch block (LBBB), True Bipolar pacing correlated with lower death (P=.022) and HF/death (P=.046) incidence.
- Adjusted analysis showed True Bipolar pacing reduced death risk by 54% (HR 0.46) and HF/death by 32% (HR 0.68) in LBBB patients, but not in non-LBBB patients. No VTA association was found.
Conclusions:
- True Bipolar LV pacing configuration is linked to significantly lower HF/death and all-cause mortality in CRT-D patients with LBBB.
- This suggests a potential benefit of specific LV lead configurations for patient outcomes in this population.
Background:
There are limited data on the significance of left ventricular (LV) lead pacing polarity to predict clinical outcomes.
Objectives:
We aimed to determine the association between the LV lead pacing polarity for heart failure (HF) or death and ventricular tachyarrhythmias (VTA) in patients enrolled in MADIT-CRT (Multicenter Automatic Defibrillator Implantation Trial with Cardiac Resynchronization Therapy), receiving a cardiac resynchronization therapy device with implanted cardioverter-defibrillator (CRT-D).
Methods:
We retrospectively analyzed LV pacing polarity. Patients with LV bipolar leads paced between LV ring and LV tip were identified as True Bipolar, while those with LV bipolar leads paced between LV tip or LV ring and right ventricular coil or unipolar leads were identified as Unipolar/Extended Bipolar. Kaplan-Meier survival analyses and multivariate Cox proportional hazards regression models were used.
Results:
Of the 969 patients, 421 had True Bipolar pacing while the remainder (n = 548) had Unipolar/Extended Bipolar pacing. Among patients with left bundle branch block (LBBB), True Bipolar pacing was associated with lower cumulative incidence of death (P = .022) and HF/death (P = .046) compared to those with Unipolar/Extended Bipolar LV pacing. After adjustment for clinical covariates, bipolar LV pacing in LBBB patients was associated with 54% lower risk for death (HR: 0.46; 95% CI: 0.24-0.88; P = .020) and 32% lower risk for HF/death (HR: 0.68; 95% CI: 0.46-1.00; P = .048) compared to Unipolar/Extended Bipolar LV pacing, but not in those with non-LBBB. No association was seen with risk of ventricular tachyarrhythmia.
Conclusion:
True Bipolar LV pacing configuration is associated with a significantly lower risk of HF/death and all-cause mortality in CRT-D patients with LBBB.
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