title: Radiographic left ventricular-right ventricular interlead distance predicts the acute hemodynamic response to cardiac resynchronization therapy.
abstract: Placement of left ventricular (LV) and right ventricular (RV) leads with maximal interlead separation is frequently sought during cardiac resynchronization therapy (CRT), but few published data are available to support this. This study examined the relation between LV and RV lead separation and the acute effects of CRT on cardiac contractility. A total of 51 consecutive patients who underwent CRT for standard indications with sufficient mitral regurgitation for echocardiographic assessment of contractility (using Doppler profiles of mitral regurgitation as a percentage of change in dP/dt [DeltadP/dt] with CRT on and off), successful transvenous LV lead placement, and postprocedural chest radiography were evaluated. The separation of the LV and RV lead tips (direct interlead distance and horizontal and vertical components) was determined on postprocedural posteroanterior and lateral radiographs. The corrected direct LV-RV interlead distance on the lateral radiograph was correlated with the DeltadP/dt (n = 51, r = 0.43, p = 0.002). The lateral interlead distance in the horizontal plane (r = 0.58, p <0.0001), but not the vertical plane (r = -0.28, p = NS), correlated with the DeltadP/dt. The corrected horizontal interlead distance on the lateral film was greater in acute hemodynamic responders to CRT (DeltadP/dt >25%) compared with nonresponders (14.4 +/- 5.4 vs 9.2 +/- 5.8 cm, p = 0.002). Other LV-RV measures on the posteroanterior and lateral radiographs did not correlate with the DeltadP/dt. Use of these findings may help to guide the sites of LV and RV lead placement to maximize the benefit derived from CRT.
authors.affiliation: Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: E Kevin
authors.initials: EK
authors.lastname: Heist
authors.forename: Dali
authors.initials: D
authors.lastname: Fan
authors.forename: Theofanie
authors.initials: T
authors.lastname: Mela
authors.forename: Daniel
authors.initials: D
authors.lastname: Arzola-Castaner
authors.forename: Vivek Y
authors.initials: VY
authors.lastname: Reddy
authors.forename: Moussa
authors.initials: M
authors.lastname: Mansour
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.forename: Jeremy N
authors.initials: JN
authors.lastname: Ruskin
authors.forename: Jagmeet P
authors.initials: JP
authors.lastname: Singh
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D018618:Echocardiography, Doppler, Color; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D009200:Myocardial Contraction / Q000502:physiology*; D013902:Radiography, Thoracic; D016896:Treatment Outcome