title: Reverse ventricular remodeling and long-term survival in patients undergoing cardiac resynchronization with surgically versus percutaneously placed left ventricular pacing leads.
abstract: BACKGROUND
  A minority of patients undergoing cardiac resynchronization therapy (CRT) use a surgically placed epicardial left ventricular (SPELV) pacing lead. Previous studies of outcomes in patients receiving such leads have been limited to small cohorts with limited follow-up.
  
  
  OBJECTIVE
  We sought to compare outcomes between patients receiving SPELV pacing leads and patients with traditional percutaneously placed left ventricular (LV) leads.
  
  
  METHODS
  We extracted clinical data on consecutive patients undergoing the new implantation of a cardiac resynchronization device. Long-term survival and response (defined as an improvement in LV ejection fraction of ≥5%) were compared between the 2 groups.
  
  
  RESULTS
  Between September 3, 2003, and August 6, 2007, 725 patients met inclusion criteria, of whom 96 (13.2%) had an SPELV pacing lead. Over a mean follow-up of 5.1 ± 2.5 years, there were 310 deaths, 17 heart transplants, and 15 left ventricular assist device placements (342 total end points). In univariate analysis, there was no difference in outcomes between patients with an SPELV pacing lead and patients with a percutaneously placed LV lead both early at 6 months (log rank, P = .53) and over a mean follow-up of 5.1 years (log rank, P = .58). In multivariate analysis, survival free of left ventricular assist device or heart transplant was similar in patients regardless of lead placement status (P = .89). From a subcohort of 455 patients, 297 patients (65.3%) met criteria for response. In multivariate analysis, there was no difference in the rate of response based on lead placement modality.
  
  
  CONCLUSIONS
  Patients undergoing epicardial LV lead placement using a surgical approach have outcomes and rates of reverse ventricular remodeling similar to those in patients undergoing LV lead placement using a percutaneous approach.
authors.affiliation: Division of Cardiology/Electrophysiology, Johns Hopkins University, Baltimore, Maryland. Electronic address: jrickar5@jhmi.edu.
authors.forename: John
authors.initials: J
authors.lastname: Rickard
authors.affiliation: Division of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Douglas R
authors.initials: DR
authors.lastname: Johnston
authors.affiliation: Division of Cardiothoracic Surgery.
authors.forename: Joel
authors.initials: J
authors.lastname: Price
authors.affiliation: Division of Cardiology/Heart Failure, John Hopkins University, Baltimore, Maryland.
authors.forename: Ryan
authors.initials: R
authors.lastname: Tedford
authors.affiliation: Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Bryan
authors.initials: B
authors.lastname: Baranowski
authors.affiliation: Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bassiouny
authors.affiliation: Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Daniel
authors.initials: D
authors.lastname: Cantillon
authors.affiliation: Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Richard A
authors.initials: RA
authors.lastname: Grimm
authors.affiliation: Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: W H Wilson
authors.initials: WHW
authors.lastname: Tang
authors.affiliation: Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Niraj
authors.initials: N
authors.lastname: Varma
authors.affiliation: Division of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Bruce L
authors.initials: BL
authors.lastname: Wilkoff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D004452:Echocardiography; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016027:Heart Transplantation / Q000706:statistics & numerical data; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000009:adverse effects / Q000706:statistics & numerical data*; D010496:Pericardium / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000401:mortality; D011379:Prognosis; D013318:Stroke Volume; D017741:Survivors / Q000706:statistics & numerical data*; D013997:Time Factors; D017211:Treatment Failure; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D016277:Ventricular Function, Left
keywords: Cardiac resynchronization therapy; Reverse ventricular remodeling; Surgically placed left ventricular pacing lead; Survival