Long-Term Outcomes of Cardiac Resynchronization Therapy Using Apical Versus Nonapical Left Ventricular Pacing

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Left ventricular (LV) apical pacing shows superior hemodynamics compared to nonapical pacing.
• Previous research suggests LV apical lead placement may be unfavorable for cardiac resynchronization therapy (CRT).
• The impact of LV apical lead position on cardiac mortality in CRT recipients remains unclear.

Purpose of the Study:

• To investigate the association between LV lead position and cardiac mortality in patients undergoing CRT.
• To determine if an apical LV lead position influences long-term cardiac survival after CRT implantation.

Main Methods:

• Retrospective observational study of 1189 patients receiving CRT over 15 years.
• LV and right ventricular lead positions (longitudinal and circumferential) assessed via fluoroscopy.
• Primary endpoint: cardiac mortality, analyzed in relation to lead positions after median 6.0-year follow-up.

Main Results:

• An apical LV lead position was linked to significantly lower cardiac mortality versus nonapical positions (aHR: 0.74; 95% CI, 0.56-0.99).
• Pump failure deaths were reduced with apical LV leads (aHR: 0.69; 95% CI, 0.51-0.94).
• Apical LV position, compared to basal, lowered sudden cardiac death risk (aHR: 0.34; 95% CI, 0.13-0.93).

Conclusions:

• In CRT recipients, an apical LV lead position is associated with improved long-term cardiac survival.
• The benefit is attributed to reduced risks of pump failure and sudden cardiac death.
• Circumferential LV and RV lead positions did not impact mortality endpoints.