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Right ventricular lead location, right-left ventricular lead interaction, and long-term outcomes in cardiac resynchronization therapy patients

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

The effects of right ventricular (RV) lead location and the combination of RV and left ventricular (LV) lead locations on long-term outcomes in patients receiving cardiac resynchronization therapy with defibrillator (CRT-D) are not well understood.

Methods

Our cohort consisted of 743 CRT-D patients from MADIT-CRT. We evaluated long-term death and combined heart failure or death (HF/death) in patients with non-apical RV vs. apical RV leads. We further assessed these long-term outcomes based on the combination of RV and LV leads, termed “RV-LV lead interaction.” Patients with non-apical RV and apical LV leads and those with apical RV and non-apical LV leads were described to have “discordant RV and LV leads.” Patients with RV and LV leads that were both non-apical or both apical were defined to have “concordant RV and LV leads.”

Results

There were no differences in death and HF/death between patients with non-apical RV vs. apical RV leads. However, patients with non-apical RV and apical LV leads had higher mortality risk, relative to those with apical RV and non-apical LV leads (HR = 4.06, 95% CI 1.73–9.53, p = 0.001) as well as those with both leads in the non-apical (HR = 3.82, 95% CI 1.33–10.98, p = 0.013) or apical (HR = 3.40, 95% CI 1.24–9.37, p = 0.018) positions. There was no difference in HF/death by RV-LV lead sub-groups.

Conclusion

Among CRT-D patients, long-term outcomes were similar for non-apical RV and apical RV leads. However, mortality risk was increased with discordant RV and LV leads, when a non-apical RV lead was combined with an apical LV lead.

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Funding

The MADIT-CRT study was supported by a research grant from Boston Scientific to the University of Rochester.

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Authors and Affiliations

  1. Heart Research Follow-Up Program and Cardiology Division, University of Rochester Medical Center, 265 Crittenden Blvd, PO Box 653, Rochester, NY, 14642, USA

    Usama A. Daimee, Helmut U. Klein, Michael C. Giudici, Wojciech Zareba, Scott McNitt, Bronislava Polonsky, Arthur J. Moss & Valentina Kutyifa

  2. The University of Iowa, Iowa City, IA, USA

    Usama A. Daimee, Helmut U. Klein, Michael C. Giudici, Wojciech Zareba, Scott McNitt, Bronislava Polonsky, Arthur J. Moss & Valentina Kutyifa

Authors
  1. Usama A. Daimee
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  2. Helmut U. Klein
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  3. Michael C. Giudici
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  4. Wojciech Zareba
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  5. Scott McNitt
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  6. Bronislava Polonsky
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  7. Arthur J. Moss
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  8. Valentina Kutyifa
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Corresponding author

Correspondence to Valentina Kutyifa.

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Conflict of interest

Drs. Klein, Zareba, Moss, and Kutyifa have received research grants from Boston Scientific.

Ethical approval

Institutional review boards approved both MADIT-CRT and the post-trial follow-up studies, and all subjects gave informed consent.

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Daimee, U.A., Klein, H.U., Giudici, M.C. et al. Right ventricular lead location, right-left ventricular lead interaction, and long-term outcomes in cardiac resynchronization therapy patients. J Interv Card Electrophysiol 52, 185–194 (2018). https://doi.org/10.1007/s10840-018-0332-4

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  • DOI: https://doi.org/10.1007/s10840-018-0332-4

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