Cardiac resynchronization therapy: predictive factors of unsuccessful left ventricular lead implant.
OBJECTIVE
Cardiac resynchronization therapy is an established therapy for advanced heart failure. However, coronary sinus access and pacing is not achieved in about 5-10% of patients. The aim of this study was to identify predictive factors for failure of left ventricular (LV) lead transvenous implant.


RESULTS
We evaluated 212 consecutive patients who received a cardiac resynchronization system. In 26 patients (12.3%), the attempt to pace the LV was unsuccessful. At univariate analysis, in patients with an unsuccessful implant a higher proportion of permanent atrial fibrillation (AF), valvular heart disease, and previous heart surgery were observed. Anteroposterior, longitudinal, and transversal left atrium diameters (LAD) were also larger among patients with an unsuccessful implant. The anteroposterior LAD (APLAD) with an optimal value to predict implant failure was 48.5 mm. At logistic regression analysis, the presence of permanent AF and APLAD were independent predictors of failed implant (OR 7.7, 95% CI 2.5-23.9, P=0.002 and OR 11.7, 95% CI 3.1-37.6, P<0.001, respectively).


CONCLUSIONS
The presence of permanent AF and APLAD are factors that predict unsuccessful pacing from the LV.
Macías
Alfonso
A
Thorax Institute, Hospital Clinic Universitari de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
García-Bolao
Ignacio
I
Díaz-Infante
Ernesto
E
Tolosana
Jose María
JM
Vidal
Bárbara
B
Gavira
Juan José
JJ
Berruezo
Antonio
A
Brugada
Josep
J
Mont
Lluis
L
D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000628:therapy*; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D017147:Defibrillators, Implantable / Q000592:standards*; D004452:Echocardiography; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D012680:Sensitivity and Specificity; D017211:Treatment Failure