Optimization of right ventricular lead position in cardiac resynchronisation therapy.
BACKGROUND
The benefit of biventricular pacing (BiV) may be substantially affected by optimal lead placement.


OBJECTIVE
To evaluate the importance of right ventricular (RV) lead positioning on clinical outcome of BiV.


RESULTS
A total of 99 patients with symptomatic heart failure and implantation of BiV system were included. Position of the left-ventricular (LV) lead was selected based on timing of local endocardial signal within the terminal portion of the QRS complex. RV lead was preferably positioned at the midseptum (n=74, RVS group) where the earliest RV endocardial signal was recorded. A subgroup of patients had RV lead placed in the apex (n=25, RVA group). NYHA class, maximum oxygen-uptake (VO(2)max), LV end-diastolic diameter (LVEDD, mm) and ejection fraction were assessed every third month. A trend towards greater improvement in NYHA class and significant increase in VO(2)max was present in the RVS group. Moreover, a significant decrease in LVEDD (DeltaLVEDD) was observed in the RVS group only (-3.4+/-6.5 mm versus +1.7+/-6.4 mm in RVA group at 12 months, p=0.004). No significant correlation between the degree of DeltaLVEDD and QRS narrowing induced by BiV was found. LVEDD reduction was predominantly present in dilated cardiomyopathy.


CONCLUSIONS
Midseptal positioning of the RV lead appears to promote reverse LV remodelling during cardiac resynchronisation therapy.
Riedlbauchová
Lucie
L
Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeòská 1958/9, 140 21 Praha 4, Prague, Czech Republic.
Cihák
Robert
R
Bytesník
Jan
J
Vancura
Vlastimil
V
Frídl
Petr
P
Hosková
Lenka
L
Kautzner
Josef
J
D002303:Cardiac Output, Low / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002908:Chronic Disease; D004567:Electrodes, Implanted; D005260:Female; D006346:Heart Septum / Q000294:innervation*; D006352:Heart Ventricles / Q000294:innervation*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D011446:Prospective Studies; D020257:Ventricular Remodeling