Left ventricular electrical delay predicts volumetric response to leadless cardiac resynchronization therapy
Nadeev Wijesuriya1, Vishal Mehta1, Felicity De Vere1
1King's College London, London, United Kingdom; Guy's and St. Thomas's NHS Foundation Trust, London, United Kingdom.
Heart Rhythm
|August 29, 2024
Summary
Identifying longer left ventricular electrical latency (Q-LV) predicts better response to leadless cardiac resynchronization therapy (CRT). Targeting these sites may improve outcomes for patients receiving leadless CRT.
Area of Science:
- Cardiology
- Medical Devices
- Electrophysiology
Background:
- Leadless left ventricular (LV) endocardial pacing is an emerging cardiac resynchronization therapy (CRT) technology.
- Predictors of response to leadless CRT are not well understood.
- Implanting the LV endocardial pacing electrode in sites with increased electrical latency (Q-LV) may improve response rates.
Purpose of the Study:
- To examine the association between Q-LV and echocardiographic remodeling response to leadless CRT.
- Investigate the efficacy of the WiSE-CRT system in relation to LV pacing site selection.
Main Methods:
- Post hoc analysis of the SOLVE-CRT trial (n=122).
- Examined relationship between LV pacing site Q-LV and left ventricular end-systolic volume (LVESV) reduction >15% at 6 months.
- Multivariable regression and receiver operating characteristic analyses were performed, with subgroup analysis for ischemic cardiomyopathy.
Main Results:
- Overall 6-month LVESV response rate was 46%.
- Q-LV was an independent predictor of response (adjusted odds ratio 1.015; P = .05).
- Response rates significantly improved in the highest Q-LV quartile (64%) compared to the lowest (28%) (P <.01), particularly in ischemic cardiomyopathy.
Conclusions:
- Increased Q-LV is associated with improved reverse remodeling after leadless CRT.
- Targeting LV endocardial sites with high Q-LV may offer additional benefits over empirical implantation.
- This finding supports personalized LV electrode placement for leadless CRT.
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