title: Fluoroscopic left ventricular lead position and the long-term clinical outcome of cardiac resynchronization therapy.
abstract: BACKGROUND
  To determine the effects of left ventricular (LV) lead tip position on the long-term outcome of cardiac resynchronization therapy (CRT).
  
  
  METHODS
  Cardiac device therapy center.
  
  
  METHODS
  Five hundred and fifty-six patients (age 70.4 ± 10.7 years [mean ± standard deviation]).
  
  
  METHODS
  CRT-pacing or CRT-defibrillation device implantation.
  
  
  METHODS
  Cardiovascular mortality and events over a maximum follow-up period of 9.1 years.
  
  
  RESULTS
  Hazard ratios (HRs [95% 785]797) for cardiovascular mortality, adjusted for age, gender, QRS duration, heart failure etiology, New York Heart Association class, and presence of diabetes and atrial fibrillation, were derived for LV lead tip positions in terms of veins, circumferential, and longitudinal positions with respect to the LV chamber. For vein position, these were 1.07 (0.74-1.56) for anterolateral vein position and 1.24 (0.79-1.95) for the middle cardiac vein, compared with a posterolateral vein. For circumferential lead tip position, HRs were 1.56 (0.73-3.34) for anterolateral and 1.57 (0.76-3.25) for lateral, compared with posterior positions. For longitudinal lead tip positions, HRs were 1.02 (0.72-1.46) for basal and 1.21 (0.68-2.17) for apical, compared with mid-ventricular positions. The risk of meeting the composite endpoints of cardiovascular death or hospitalizations for heart failure and death from any cause or hospitalizations for major adverse cardiovascular events was similar among the various LV lead tip positions.
  
  
  CONCLUSIONS
  The position of the LV lead over the LV free wall, assessed by fluoroscopy, has no influence over the long-term outcome of CRT.
authors: Department of Cardiology, Good Hope Hospital, University of Birmingham, Sutton Coldfield, United Kingdom.
authors: Paul W X
authors: PW
authors: Foley
authors: Shajil
authors: S
authors: Chalil
authors: Karim
authors: K
authors: Ratib
authors: Russell
authors: R
authors: Smith
authors: Frits
authors: F
authors: Prinzen
authors: Angelo
authors: A
authors: Auricchio
authors: Francisco
authors: F
authors: Leyva
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D058409:Cardiac Resynchronization Therapy Devices; D005260:Female; D005471:Fluoroscopy; D006801:Humans; D008297:Male; D011446:Prospective Studies; D019919:Prosthesis Implantation / Q000379:methods; D016896:Treatment Outcome