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Relationship between left ventricular lead position using a simple radiographic classification scheme and long-term outcome with resynchronization therapy

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Abstract

Background

Benefit from cardiac resynchronization therapy (CRT) is likely influenced by the location of the left ventricular (LV) lead.

Purpose

To evaluate the association of LV lead position with outcome after CRT.

Methods

Two-hundred and fifty patients with LV dysfunction, New York Heart Association (NYHA) class III (68%) or IV (32%) symptoms, and QRS durations ≥120 ms were followed for a median of 30 months post-CRT. LV lead position was categorized as anterior (n = 20, 8%), lateral (n = 128, 51%), or posterior (n = 102; 41%) using postero-anterior and lateral postoperative chest radiographs.

Results

Median age was 69 years and most (68%) had ischemic LV dysfunction. Clinical response, defined by a ≥1 NYHA class reduction, was lower in patients with an anterior (30%) versus lateral (76%) or posterior (73%) lead position (p = 0.001). An anterior versus nonanterior position was independently associated with a two to three-fold higher risk for nonresponse to CRT, cardiovascular death, death from worsening heart failure or cardiac transplantation, and death from any cause. Repositioning of the LV lead from an anterior to a nonanterior position in seven patients who had not clinically responded to CRT after ≥6 months resulted in clinical improvement in all cases.

Conclusions

An anterior versus nonanterior LV lead position is independently associated with an increased likelihood of nonresponse to CRT and a higher risk of serious outcomes. Repositioning of an anteriorly placed LV lead to a nonanterior position should be considered in CRT nonresponders.

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Authors and Affiliations

  1. Libin Cardiovascular Institute of Alberta, University of Calgary, G208; 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada

    Stephen B. Wilton, Mariko A. Shibata, Rachel Sondergaard, Karen Cowan, Lisa Semeniuk & Derek V. Exner

Authors
  1. Stephen B. Wilton
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  2. Mariko A. Shibata
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  3. Rachel Sondergaard
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  4. Karen Cowan
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  5. Lisa Semeniuk
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  6. Derek V. Exner
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Corresponding author

Correspondence to Derek V. Exner.

Additional information

Dr. Wilton is a Canadian Institutes of Health Research (CIHR) Strategic Training Fellow in Tomorrow’s Research Cardiovascular Health Professionals (TORCH). Dr. Exner is a CIHR Clinical Investigator and Scholar of the Alberta Heritage Foundation for Medical Research.

Dr. Exner has received research grants and consulting fees from Medtronic Inc., Boston Scientific and St. Jude Medical. Dr. Semeniuk is now employed by Johnson & Johnson.

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Wilton, S.B., Shibata, M.A., Sondergaard, R. et al. Relationship between left ventricular lead position using a simple radiographic classification scheme and long-term outcome with resynchronization therapy. J Interv Card Electrophysiol 23, 219–227 (2008). https://doi.org/10.1007/s10840-008-9287-1

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  • DOI: https://doi.org/10.1007/s10840-008-9287-1

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