title: Mortality and morbidity in cardiac resynchronization patients: impact of lead position, paced left ventricular QRS morphology and other characteristics on long-term outcome.
abstract: OBJECTIVE
  To investigate the effect of implantation-related characteristics, especially lead position and left ventricular (LV)-paced QRS morphology, on long-term mortality and morbidity in cardiac resynchronization therapy (CRT) patients.
  
  
  RESULTS
  The study retrospectively analysed 362 consecutive patients who underwent CRT device implantation over a 6 year period. Pre-implantation, LV-only paced, and biventricularly paced 12-lead electrocardiograms were obtained. Left ventricular and right ventricular (RV) lead positions were determined using biplane fluoroscopy and roentgenograms. The Kaplan-Meier method was used to estimate the survival function for all-cause death/hospitalization and cardiovascular death/hospitalization. Univariate and multivariate Cox proportional hazards models were also applied. The mean follow-up time was 24.7 ± 16.9 months. There were 79 deaths (62 cardiovascular) and 99 unplanned hospitalizations (72 cardiovascular). One year and 2 year all-cause mortality rates were 8.5 and 18.0%, respectively. Electrocardiographic and fluoroscopic descriptors of the LV lead position were found to be predictors of mortality/morbidity (as were functional class, heart failure aetiology, hyponatremia, and chronic atrial fibrillation). In particular, the antero-apical pattern of LV-only paced QRS showed a hazard ratio (HR) of 1.8 in univariate and 1.7 in multivariate analysis for predicting all-cause death/hospitalization (P = 0.006). The apical/paraseptal LV lead position showed an HR of 2.1 in univariate and 1.9 in multivariate analysis for predicting cardiovascular death/hospitalization (P = 0.018).
  
  
  CONCLUSIONS
  To achieve better long-term outcomes in CRT patients the antero-apical pattern of LV QRS complexes and apical or paraseptal LV lead position should be avoided.
authors.affiliation: First Department of Cardiology and Hypertension, University Hospital, ul. Kopernika 17, 31-501 Cracow, Poland. mcjastrz@cyf-kr.edu.pl
authors.forename: Marek
authors.initials: M
authors.lastname: Jastrzebski
authors.forename: Jerzy
authors.initials: J
authors.lastname: Wilinski
authors.forename: Kamil
authors.initials: K
authors.lastname: Fijorek
authors.forename: Tomasz
authors.initials: T
authors.lastname: Sondej
authors.forename: Danuta
authors.initials: D
authors.lastname: Czarnecka
mesh_terms: D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000706:statistics & numerical data*; D004562:Electrocardiography; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D005471:Fluoroscopy; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006352:Heart Ventricles; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D011379:Prognosis; D016016:Proportional Hazards Models; D013995:Time; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000401:mortality / Q000628:therapy