This Article Figures Only Full Text Full Text (PDF) View Related Journal Scan on Cardiosource Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (12) Citing Articles via Google Scholar Google Scholar Articles by Ypenburg, C. Articles by Bax, J. J. Search for Related Content PubMed Articles by Ypenburg, C. Articles by Bax, J. J. Related Collections Related Articles

CLINICAL RESEARCH: CARDIAC RESYNCHRONIZATION THERAPY

Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization Therapy

Claudia Ypenburg, MD^_*, Rutger J. van Bommel, MD^_*, Victoria Delgado, MD^_*, Sjoerd A. Mollema, MD^_*, Gabe B. Bleeker, MD, PhD^_*, Eric Boersma, PhD, Martin J. Schalij, MD, PhD^_* and Jeroen J. Bax, MD, PhD^_*,_*

^_* Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
Department of Epidemiology and Statistics, Erasmus University, Rotterdam, the Netherlands

Manuscript received March 26, 2008; revised manuscript received June 2, 2008, accepted June 17, 2008.

^_* Reprint requests and correspondence: Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands (Email: j.j.bax{at}lumc.nl).

Objectives: The aim of the current study was to evaluate echocardiographic parameters after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome in patients with the left ventricular (LV) lead positioned at the site of latest activation (concordant LV lead position) as compared with that seen in patients with a discordant LV lead position.

Background: A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT.

Methods: The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest X-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure.

Results: Significant LV reverse remodeling (reduction in LV end-systolic volume from 189 ± 83 ml to 134 ± 71 ml, p < 0.001) was noted in the group of patients with a concordant LV lead position (n = 153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32 ± 16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, p = 0.004).

Conclusions: Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up.

Key Words: resynchronization therapy • lead position • echocardiography • heart failure

Abbreviations and Acronyms   CI = confidence interval   CRT = cardiac resynchronization therapy   HR = hazard ratio   LV = left ventricle/ventricular   LVEDV = left ventricular end-diastolic volume   LVEF = left ventricular ejection fraction   LVESV = left ventricular end-systolic volume   NYHA = New York Heart Association   PH = proportional hazards   2D = two-dimensional

Related Articles

The Riddle of Determining Cardiac Resynchronization Therapy Response: A Physiologic Approach to Dyssynchrony Therapy

Thomas H. Marwick and Randall C. Starling
J. Am. Coll. Cardiol. 2008 52: 1410-1412. [Full Text] [PDF]

This article has been cited by other articles:

				F. Z. Khan, M. S. Virdee, D. Gopalan, J. Rudd, T. Watson, S. P. Fynn, and D. P. Dutka Characterization of the suitability of coronary venous anatomy for targeting left ventricular lead placement in patients undergoing cardiac resynchronization therapy Europace, November 1, 2009; 11(11): 1491 - 1495. [Abstract] [Full Text] [PDF]

				N. R. Van de Veire, V. Delgado, J. D. Schuijf, E. E. van der Wall, M. J. Schalij, and J. J. Bax The role of non-invasive imaging in patient selection Europace, November 1, 2009; 11(suppl_5): v32 - v39. [Abstract] [Full Text] [PDF]

				J. M. Morgan and V. Delgado Lead positioning for cardiac resynchronization therapy: techniques and priorities Europace, November 1, 2009; 11(suppl_5): v22 - v28. [Abstract] [Full Text] [PDF]

				M. B. Kronborg, A. E. Albertsen, J. C. Nielsen, and P. T. Mortensen Long-term clinical outcome and left ventricular lead position in cardiac resynchronization therapy Europace, September 1, 2009; 11(9): 1177 - 1182. [Abstract] [Full Text] [PDF]

				M. Biffi, C. Moschini, M. Bertini, D. Saporito, M. Ziacchi, I. Diemberger, C. Valzania, G. Domenichini, E. Cervi, C. Martignani, et al. Phrenic Stimulation: A Challenge for Cardiac Resynchronization Therapy Circ Arrhythm Electrophysiol, August 1, 2009; 2(4): 402 - 410. [Abstract] [Full Text] [PDF]

				J. E. Sanderson Echocardiography for cardiac resynchronization therapy selection: fatally flawed or misjudged? J. Am. Coll. Cardiol., May 26, 2009; 53(21): 1960 - 1964. [Abstract] [Full Text] [PDF]

				O. A. Breithardt Echocardiographic patient selection for cardiac resynchronization therapy betting on a dead horse? J. Am. Coll. Cardiol. Img., May 1, 2009; 2(5): 544 - 547. [Full Text] [PDF]

				M. M. Boogers, S. D. Van Kriekinge, M. M. Henneman, C. Ypenburg, R. J. Van Bommel, E. Boersma, P. Dibbets-Schneider, M. P. Stokkel, M. J. Schalij, D. S. Berman, et al. Quantitative Gated SPECT-Derived Phase Analysis on Gated Myocardial Perfusion SPECT Detects Left Ventricular Dyssynchrony and Predicts Response to Cardiac Resynchronization Therapy J. Nucl. Med., May 1, 2009; 50(5): 718 - 725. [Abstract] [Full Text] [PDF]

				C. Alonso In the field of cardiac resynchronization therapy is left ventricular pacing via the coronary sinus a mature technique Europace, May 1, 2009; 11(5): 544 - 545. [Full Text] [PDF]

				F. Z. Khan, M. S. Virdee, S. P. Fynn, and D. P. Dutka Left ventricular lead placement in cardiac resynchronization therapy: where and how? Europace, May 1, 2009; 11(5): 554 - 561. [Abstract] [Full Text] [PDF]

				A. E. Weyman The year in echocardiography. J. Am. Coll. Cardiol., April 28, 2009; 53(17): 1558 - 1567. [Full Text] [PDF]

				L. F. Tops and J. J. Bax The Year in Imaging Related to Electrophysiology J. Am. Coll. Cardiol. Img., April 1, 2009; 2(4): 498 - 510. [Full Text] [PDF]

				A. N. DeMaria, O. Ben-Yehuda, J. J. Bax, G. K. Feld, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, S. M. Narayan, D. J. Sahn, et al. Highlights of the Year in JACC 2008. J. Am. Coll. Cardiol., January 27, 2009; 53(4): 373 - 398. [Full Text] [PDF]

				S. Lafitte, P. Reant, A. Zaroui, E. Donal, A. Mignot, H. Bougted, H. Belghiti, P. Bordachar, A. Deplagne, J. Chabaneix, et al. Validation of an echocardiographic multiparametric strategy to increase responders patients after cardiac resynchronization: a multicentre study Eur. Heart J., January 9, 2009; (2009) ehn582v1. [Abstract] [Full Text] [PDF]

				J. D. Schuijf, N. R. Van de Veire, E. E. van der Wall, and J. J. Bax CHAPTER 3 Choice of Imaging Techniques ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]

				T. H. Marwick and R. C. Starling The Riddle of Determining Cardiac Resynchronization Therapy Response: A Physiologic Approach to Dyssynchrony Therapy J. Am. Coll. Cardiol., October 21, 2008; 52(17): 1410 - 1412. [Full Text] [PDF]