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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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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DOI: https://doi.org/10.1007/s10840-011-9630-9