Three-dimensional interlead distance predicts response and outcomes after cardiac resynchronization therapy
Nicolas Clementy1, Guillaume Laborie1, Bertrand Pierre1
1Cardiology Department, François Rabelais University, Tours, France.
Archives of Cardiovascular Diseases
|July 24, 2017
Summary
A longer three-dimensional interlead distance (ILD) measured on chest X-rays predicts better response to cardiac resynchronization therapy (CRT). This simple measurement can guide optimal lead placement for improved patient outcomes.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Cardiac resynchronization therapy (CRT) is ineffective in approximately one-third of patients.
- Optimizing ventricular lead placement may enhance CRT response rates.
Purpose of the Study:
- To investigate the impact of true three-dimensional interlead distance (ILD) on CRT outcomes.
- To determine if ILD can serve as a predictor of CRT response.
Main Methods:
- Prospective implantation of CRT devices in consecutive patients.
- Measurement of interlead separation from postprocedural chest X-rays (anterior-posterior and lateral views).
- Calculation of three-dimensional ILD using the Pythagorean theorem; CRT response assessed at 6 months.
Main Results:
- Responders to CRT exhibited a significantly longer ILD (108±17mm vs. 87±21mm).
- An ILD indexed to cardiac size (≥ 0.53) accurately predicted CRT response (AUC 0.84).
- An indexed ILD ≥ 0.53 was associated with a 70% reduction in heart failure hospitalization risk.
Conclusions:
- A longer, cardiac size-corrected three-dimensional ILD on chest radiographs reliably predicts CRT response and clinical outcomes.
- This simple metric can guide optimal lead positioning and pacing configurations during CRT implantation procedures.
