The impact of left ventricular lead position on left ventricular reverse remodelling and improvement in mechanical dyssynchrony in cardiac resynchronization therapy.
OBJECTIVE
To investigate the influence of left ventricular (LV) lead position on LV dyssynchrony in cardiac resynchronization therapy (CRT).


RESULTS
The LV lead was prospectively targeted to the latest activated LV segment (concordant) evaluated by two-dimensional speckle tracking radial strain (ST-RS) echocardiography in 103 CRT recipients (67 ± 12 years). Mechanical dyssynchrony was assessed by anteroseptal-to-posterior (AS-P) delay and interventricular mechanical delay (IVMD). Concordant LV leads were obtained in 72 (70%) patients. Superior LV reverse remodelling (LV-RR; ≥ 15% LV end-systolic volume reduction at 6-month follow-up) was observed in the concordant LV leads compared with the discordant LV leads [51 (76%) vs. 13 (45%); P = 0.003]. Mechanical resynchronization responders (≥ 50% AS-P delay reduction at 6-month follow-up) obtained in the concordant LV leads [44 (66%)] was greater than in the discordant LV leads [10 (34%); P = 0.005]. The discordant LV leads located adjacent to the concordant LV leads (+1 segment; n = 22) and 2 segments apart (+2 segments; n = 9) were evaluated in a subgroup analysis. Mechanical resynchronization responders 6 months after CRT were as follows: in +1 segment [n = 10 (48%)] and in +2 segments (n = 0; P = 0.001). The concordant LV lead was the only independent predictor of LV-RR at 6-month follow-up (odds ratio, 4.177; P = 0.004). Independent predictors of mechanical resynchronization responders were AS-P delay (odds ratio, 1.007; P = 0.032), IVMD (odds ratio, 1.024; P = 0.038), and concordant LV lead (odds ratio, 4.691; P = 0.004).


CONCLUSIONS
Concordant LV leads in CRT provided more responders according to both LV reverse remodelling and mechanical resynchronization.
Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway. hans.morten.kristiansen@helse-bergen.no
H M
HM
Kristiansen
G
G
Vollan
T
T
Hovstad
H
H
Keilegavlen
S
S
Faerestrand
D000368:Aged; D000704:Analysis of Variance; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D016009:Chi-Square Distribution; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy*; D020257:Ventricular Remodeling