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Cardiac computed tomography-verified right ventricular lead position and outcomes in cardiac resynchronization therapy

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Abstract

Purpose

To evaluate the association between different right ventricular (RV) lead positions as assessed by cardiac computed tomography (CT) and echocardiographic and clinical outcomes in patients receiving cardiac resynchronization therapy (CRT).

Methods

We reviewed patient records of all 278 patients included in two randomized controlled trials (ImagingCRT and ElectroCRT) for occurrence of heart failure (HF) hospitalization or all-cause death (primary endpoint) during long-term follow-up. Outcomes were compared between RV lead positions using adjusted Cox regression analysis. Six months after CRT implantation, we estimated left ventricular (LV) reverse remodeling by measuring LV end-systolic and end-diastolic volumes by echocardiography. Changes from baseline to 6 months follow-up were compared between RV lead positions. Device-related complications were recorded at 6-month follow-up.

Results

During median (interquartile range) follow-up of 4.7 (2.9–7.1) years, the risk of meeting the primary endpoint was similar for patients with non-apical vs. apical RV lead position (adjusted hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.54–1.12, p = 0.17) and free wall vs. septal RV lead position (adjusted HR 1.03, 95% CI 0.72–1.47, p = 0.86).

Changes in LV ejection fraction and dimensions were similar with the different RV lead positions. We observed no differences in device-related complications relative to the RV lead position.

Conclusions

In patients receiving CRT, the risk of HF hospitalization or all-cause death during long-term follow-up, and LV remodeling and incidence of device-related complications after 6 months are not associated with different anatomical RV lead position as assessed by cardiac CT.

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Funding

This work was supported by Aarhus University, the Danish Heart Foundation (grant number R140-A9482-B2407), Health Research Foundation of Central Denmark Region (grant number R64-A3194-B1667), and Gangstedfonden.

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Authors and Affiliations

  1. Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark

    Daniel Benjamin Fyenbo, Charlotte Stephansen, Bjarne Linde Nørgaard, Mads Brix Kronborg, Jens Kristensen, Christian Gerdes, Henrik Kjærulf Jensen, Jesper Møller Jensen & Jens Cosedis Nielsen

  2. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Daniel Benjamin Fyenbo, Mads Brix Kronborg, Henrik Kjærulf Jensen & Jens Cosedis Nielsen

  3. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark

    Anders Sommer

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  1. Daniel Benjamin Fyenbo
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  2. Anders Sommer
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Corresponding author

Correspondence to Daniel Benjamin Fyenbo.

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Conflict of interest

JCN is supported by grants from the Novo Nordisk Foundation (grant number NNF16OC0018658, NNF17OC0029148). HKJ is supported by grants from the Novo Nordisk Foundation, Denmark (NNF18OC0031258 and NNF20OC0065151), and received lecture fees from Abbott Denmark and Biosense Webster, Europe. All other declare no conflicts of interest.

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Fyenbo, D.B., Sommer, A., Stephansen, C. et al. Cardiac computed tomography-verified right ventricular lead position and outcomes in cardiac resynchronization therapy. J Interv Card Electrophysiol 64, 783–792 (2022). https://doi.org/10.1007/s10840-022-01193-1

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  • DOI: https://doi.org/10.1007/s10840-022-01193-1

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