Influence of left ventricular lead location on outcomes in the COMPANION study.
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.
Saxon
Leslie A
LA
Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA. saxon@usc.edu
Olshansky
Brian
B
Volosin
Kent
K
Steinberg
Jonathan S
JS
Lee
Byron K
BK
Tomassoni
Gery
G
Guarnieri
Thomas
T
Rao
Anupama
A
Yong
Patrick
P
Galle
Elizabeth
E
Leigh
Jill
J
Ecklund
Fred
F
Bristow
Michael R
MR
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
D002317:Cardiovascular Agents