Europace Advance Access published online on August 11, 2008
Europace, doi:10.1093/europace/eun208
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Impact of interventricular lead distance and the decrease in septal-to-lateral delay on response to cardiac resynchronization therapy
1 Department of Cardiology, Thoraxcenter, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB Groningen, The Netherlands; 2 The Interuniversity Cardiology Institute Netherlands, Utrecht, The Netherlands
Aims: To investigate the influence of interlead distance and lead positioning on success of cardiac resynchronization therapy (CRT) in patients with advanced chronic heart failure and electrical dyssynchrony. Despite application of established selection criteria, 20–40% of the patients do not respond to CRT.
Methods and results: We examined consecutive patients in whom CRT was implanted. Response to CRT was defined as a decrease in the left ventricular end-systolic volume 
10% after 6 months. A comparison was made between patients who were responders to CRT and those who were non-responders. A univariate and stepwise multivariate logistic regression was performed with regard to predictors for response. Between January 2004 and January 2008, 174 patients who were treated with CRT were classified as responders [n = 95 (55%)] or non-responders [n = 79 (45%)]. Responders had a significantly larger horizontal interlead distance on the lateral thoracic X-ray [odds ratio (OR) 2.8 (1.2–6.6), P = 0.01], a septal-to-lateral delay >60 ms [OR 4.9 (2.0–11.4), P < 0.0001], non-ischaemic cardiomyopathy [OR 3.0 (1.3–6.9), P = 0.009], a left ventricular end-diastolic diameter <67 mm [OR 4.2 (1.8–9.9), P = 0.001], angiotensin-converting enzyme inhibitor use [OR 8.1 (1.7–38.2), P = 0.008], and no tricuspid valve insufficiency [OR 6.9 (1.3–35.5), P = 0.02]. Post-implantation responders had a significantly greater decrease in the intraventricular delay (septal-to-lateral delay 62 ± 62 vs. 26 ± 65 ms, P = 0.001), but not in the interventricular mechanical delay.
Conclusion: Larger interlead distance on the lateral thoracic X-ray, associated with positioning of the left ventricular lead in the posterior position, is associated with response after 6 months of follow-up. Furthermore, diminishing the septal-to-lateral delay is predictive for response.
Key Words: Congestive heart failure, Artificial pacing, Cardiac resynchronization therapy
* Corresponding author. Tel: +31 50 361 2355; fax: +31 50 361 4391. E-mail address: i.c.van.gelder{at}thorax.umcg.nl
Manuscript submitted 4 June 2008. Accepted after revision 19 July 2008.
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