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ICD lead type and RV lead position in CRT-D recipients

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Abstract

Background

Data on preferred ICD lead type and optimal RV lead position in patients undergoing CRT-D implantation are limited.

Objectives

To compare dual- versus single-coil ICD leads and non-apical versus apical RV lead position and their impact on clinical parameters and survival in CRT-D recipients.

Methods

A total of 563 consecutive patients with advanced heart failure and indication for CRT-D implantation were enrolled in two European tertiary centers. Endpoints were improvement in NYHA functional class, changes in echo- and electrocardiographic parameters, and all-cause and cardiovascular mortality.

Results

In this retrospective analysis, a total of 313 (56%) dual- and 250 (44%) single-coil ICD leads were used. RV leads were placed non-apically in 262 (47%) and apically in 296 (53%) patients, respectively. Over a mean follow-up of 41 ± 34 months, all-cause mortality and cardiovascular mortality were similar for patients with dual- versus single-coil ICD lead (adjusted HR 0.81, 95% CI 0.58–1.12 and aHR 1.22, 95% CI 0.73–2.04) and non-apical versus apical RV lead position (aHR 0.98, 95% CI 0.71–1.36 and aHR 0.76, 95% CI 0.44–1.31). Non-apical RV lead position was associated with greater reduction in QRS duration after CRT implantation (− 14.4 ± 32.1 vs. − 4.3 ± 34.3 ms, p < 0.001).

Conclusions

We found no association between ICD lead type or RV lead position and outcomes in CRT-D recipients. Non-apical RV lead position was associated with larger reduction in QRS duration.

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Acknowledgements

The assistance of Antje Steidl is greatly appreciated by the authors. We thank Prof. Eva Herrmann for her advice in the statistical part of the study.

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Authors and Affiliations

  1. Division Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany

    Alexander P. Benz, Mate Vamos, Julia W. Erath & Stefan H. Hohnloser

  2. Department of Cardiology, Medical Centre, Hungarian Defence Forces, Róbert Károly krt. 44, Budapest, 1134, Hungary

    Peter Bogyi & Gabor Z. Duray

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  1. Alexander P. Benz
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Correspondence to Stefan H. Hohnloser.

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Conflict of interest

Alexander P. Benz reports support to attend a scientific meeting from St. Jude Medical/Abbott. Mate Vamos reports lecture fees from Bayer, Pfizer and Spectranetics and support to attend scientific meetings from Bayer, Boston Scientific, Pfizer, and SJM, outside the submitted work. Julia W. Erath reports receiving lecture fees and support to attend scientific meetings from Zoll Medical and Servier, and is a fellow of the Boston Scientific heart rhythm fellowship program, outside the submitted work. Peter Bogyi has nothing to report. Gabor Z. Duray received lecture and consulting fees from Medtronic, Biotronik, SJM, and Johnson&Johnson, outside the submitted work. Stefan H. Hohnloser received consulting fees Bayer, BI, Boston Scientific, BMS, Cardiome, Gilead, J&J, Medtronic, Pfizer, SJM, Sanofi-Aventis, and Zoll Medical, outside the submitted work.

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Benz, A.P., Vamos, M., Erath, J.W. et al. ICD lead type and RV lead position in CRT-D recipients. Clin Res Cardiol 107, 1122–1130 (2018). https://doi.org/10.1007/s00392-018-1286-3

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  • DOI: https://doi.org/10.1007/s00392-018-1286-3

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