Long-term hemodynamic benefit of biventricular pacing depending on coronary sinus lead position.
BACKGROUND
Acute studies in cardiac resynchronization therapy (CRT) showed that hemodynamic effects may depend on the coronary sinus (CS) lead position. However, there are no data on the longterm effect of CS lead position.


METHODS
In 45 heart failure patients with left bundle branch block and QRS >150 ms (age 59+/-10 years, 17 dilative cardiomyopathy, 23 ischemic, 5 valvular), biventricular pacemakers were implanted. CS leads were positioned in posterior (P, n=15), lateral (L, n=19) or, if no other option available, anterior (A, n=11) side branches. Before and 6 months after implantation, clinical state, echocardiography, brain natriuretic peptide (BNP) and right heart catheterization were evaluated.


RESULTS
Baseline parameters were similar between groups. After 6 months, there were 32/34 responders in groups P and L compared to 7/11 responders in group A (94 vs groups P and L: Arterial pressure +8 and +9% vs +2%; PCWP -23 and -15% vs -4%, pulmonary pressure -18 and -12% vs -3% (p<0.01 for A vs P+L); cardiac index +21 and +12% vs +11% (p=0.03 for A vs P). BNP was reduced by 55, 35, and 27% (p=0.05 for A vs P). Ejection fraction increased in P and L by 40 and 41%, respectively, but only by +19% in A (p<0.03 for A vs P+L).


CONCLUSIONS
Chronic CRT improves ejection fraction, BNP and hemodynamic measurements predominantly in patients with lateral and posterior CS lead positions. Anterior lead positions should be avoided.
Nägele
H
H
Gustav-Adolf-Stift, 21465 Reinbek, Germany. Herbert_naegele@yahoo.de
Hashagen
S
S
Azizi
M
M
Behrens
S
S
Castel
M A
MA
D000368:Aged; D001794:Blood Pressure / Q000502:physiology*; D002037:Bundle-Branch Block / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D002245:Carbon Dioxide / Q000097:blood; D006328:Cardiac Catheterization; D002302:Cardiac Output / Q000502:physiology*; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate / Q000502:physiology*; D006452:Hemoglobinometry; D006801:Humans; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology*; D010100:Oxygen / Q000097:blood; D010138:Pacemaker, Artificial; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D013318:Stroke Volume / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology
D002245:Carbon Dioxide; D010100:Oxygen