Europace Advance Access originally published online on August 6, 2009
Europace 2009 11(9):1177-1182; doi:10.1093/europace/eup202
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Pacing and CRT
Long-term clinical outcome and left ventricular lead position in cardiac resynchronization therapy
1 Department of Cardiology, Aarhus University Hospital, Skejby, Bendstrupgaardsvej 100, DK- 8200 Aarhus N, Denmark; 2 Department of Cardiology, Viborg Regional Hospital, Viborg, Denmark
Aims: To identify the predictive value of a presumed optimal left ventricular lead positions (LV-Ps) on the long-term clinical outcome in patients with cardiac resynchronization therapy (CRT).
Methods and results: Clinical information was collected from patient files in consecutive patients treated with CRT from 1997 to 2007. A presumed optimal LV-Ps were defined as a position between 2 and 5 o'clock in the short-axis circumference and basal or mid-ventricular in the long axis. Symptomatic response was defined as improvement in NYHA class (
1) and echocardiographic response as improvement in left ventricular ejection fraction of 5% absolute. We included 567 patients [median age 66 years, 453 (80%) male]. The LV-Ps were optimal in 334 (59%) patients. The hazard ratio for all-cause mortality with an optimal LV-Ps was unadjusted 0.79 (0.59–1.06) and adjusted 0.99 (0.71–1.40). The odds ratio (OR) for symptomatic response with an optimal LV-Ps was unadjusted 1.13 (0.79–1.64) and adjusted 1.05 (0.67–1.64), and the OR for echocardiographic response was unadjusted 1.60 (1.02–2.49) and adjusted 1.42 (0.88–2.31).
Conclusion: A presumed optimal LV-Ps between 2 and 5 o'clock in the short-axis circumference and basal or mid-ventricular in the long axis is not associated with a lower mortality or a better clinical response in patients treated with CRT.
Key Words: Cardiac resynchronization therapy, Biventricular pacing, Left ventricular leads, Mortality, Heart failure
* Corresponding author. Tel: +45 89 49 62 34, Fax: +45 89 49 60 02, Email: mads.brix.kronborg{at}ki.au.dk or mbk5{at}hotmail.com
Manuscript submitted 12 May 2009. Accepted after revision 29 June 2009.
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  M. B. Kronborg, J. C. Nielsen, and P. T. Mortensen Electrocardiographic patterns and long-term clinical outcome in cardiac resynchronization therapy Europace, November 14, 2009; (2009) eup364v1. [Abstract] [Full Text] [PDF]
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