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Adverse response to cardiac resynchronisation therapy in patients with septal scar on cardiac MRI preventing a septal right ventricular lead position

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Abstract

Purpose

Myocardial scar is an adverse factor when considering which patients are likely to respond to cardiac resynchronisation therapy (CRT). We hypothesized that septal scarring on magnetic resonance imaging (MRI) may be associated with a poor outcome from CRT, which may relate to the inability to place the right ventricular (RV) lead in the septum.

Methods

Fifty patients (ejection fractions, 25 ± 8%; 45 men, 62.8 ± 14 years; 26 dilated cardiomyopathy; and 24 ischaemic cardiomyopathy (ICM)) receiving CRT underwent delayed enhancement cardiac MRI to assess location and burden of myocardial scar. Acute hemodynamic response (AHR) was evaluated at implant with a pressure wire in the left ventricular (LV) cavity. LV remodelling was determined by reduction in LV end-systolic volume at 6 months.

Results

The presence of ICM with septal scar was associated with a poor acute and chronic response to CRT. This was predominantly due to a worse response in patients with septal scar. Patients without septal scar had a better AHR with a 26.7 ± 28.9% rise in LV dP/dt max from baseline vs. −2.8 ± 14.5% for patients with septal scar (P = 0.01) with Biventricular (BIV) pacing. A greater proportion remodelled (56% vs. 20% (P = 0.02)). Furthermore, only 33% of patients with septal scar had an RV septal lead compared with 66% with no septal scar (P = 0.03).

Conclusions

The presence of septal scar was associated with a poor acute and chronic response to CRT. This may relate to the inability to achieve a RV septal lead placement.

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Grant support

This study is supported by the European Community’s Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 224495 (euHeart project).

Disclosure and relationships to industry

Drs. Matthew Ginks and Anoop Shetty receive research funding from St. Jude Medical. Professor Reza receives research funding from Philips Healthcare. Dr. C Aldo Rinaldi is a Consultant to St. Jude Medical.

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Authors and Affiliations

  1. Department of Imaging Sciences, The Rayne Institute, Kings College London, London, Great Britain, UK

    Simon G. Duckett, Matthew Ginks, Anoop Shetty, Senthil Kirubakaran, Jaswinder Gill, Reza Razavi & C. Aldo Rinaldi

  2. The Department of Cardiology, Guy’s and St. Thomas’ Hospital, London, Great Britain, UK

    Simon G. Duckett, Matthew Ginks, Anoop Shetty, Senthil Kirubakaran, Julian Bostock, Stam Kapetanakis, Jaswinder Gill, Gerry Carr-White, Reza Razavi & C. Aldo Rinaldi

  3. Division of Imaging Sciences, The Rayne Institute, 4th Floor, Lambeth Wing, St. Thomas’ Hospital, London, SE1 7EH, UK

    Simon G. Duckett

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  1. Simon G. Duckett
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Correspondence to Simon G. Duckett.

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Duckett, S.G., Ginks, M., Shetty, A. et al. Adverse response to cardiac resynchronisation therapy in patients with septal scar on cardiac MRI preventing a septal right ventricular lead position. J Interv Card Electrophysiol 33, 151–160 (2012). https://doi.org/10.1007/s10840-011-9630-9

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