title: Influence of left ventricular lead location on outcomes in the COMPANION study.
abstract: BACKGROUND
  There are no randomized controlled trial data that evaluate mortality and hospitalization rates in cardiac resynchronization therapy (CRT) recipients based on left ventricular (LV) lead location. We analyzed the event-driven outcomes of mortality and hospitalization as well as functional outcomes including Functional Class, Quality-of-Life, and 6-minute walk distance in 1,520 patients enrolled in the COMPANION study of CRT versus optimal medical therapy.
  
  
  RESULTS
  Over a mean follow-up after implantation of 16.2 months, patients randomized to CRT, regardless of lead location, experienced benefit compared with optimized pharmacologic therapy (OPT), with respect to all-cause mortality or heart failure hospitalization. All but a posterior location showed benefit with respect to the all-cause mortality or all-cause hospitalization outcome. Mortality benefit in CRT-D patients was indifferent to LV lead position. All functional outcomes including 6-minute walk distance, Quality-of-Life (QOL) and Functional Class improved with CRT, regardless of LV lead location.
  
  
  CONCLUSIONS
  LV lead location was not a major determinant of multiple measures of response to CRT therapy in the COMPANION Trial. While acute data indicate that a left lateral LV lead location results in the most favorable hemodynamic response, these chronic data suggest that positioning an LV lead in an anterior rather than a lateral or posterior LV location has similar benefit.
authors.affiliation: Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. saxon@usc.edu
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Saxon
authors.forename: Brian
authors.initials: B
authors.lastname: Olshansky
authors.forename: Kent
authors.initials: K
authors.lastname: Volosin
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Steinberg
authors.forename: Byron K
authors.initials: BK
authors.lastname: Lee
authors.forename: Gery
authors.initials: G
authors.lastname: Tomassoni
authors.forename: Thomas
authors.initials: T
authors.lastname: Guarnieri
authors.forename: Anupama
authors.initials: A
authors.lastname: Rao
authors.forename: Patrick
authors.initials: P
authors.lastname: Yong
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Galle
authors.forename: Jill
authors.initials: J
authors.lastname: Leigh
authors.forename: Fred
authors.initials: F
authors.lastname: Ecklund
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bristow
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects* / Q000401:mortality; D002317:Cardiovascular Agents / Q000009:adverse effects*; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D004554:Electric Countershock / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006352:Heart Ventricles / Q000503:physiopathology; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D016016:Proportional Hazards Models; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D016138:Walking
chemical_list: D002317:Cardiovascular Agents