title: Impact of the Right Ventricular Lead Position on Clinical End Points in CRT Recipients--A Subanalysis of the Multicenter Randomized SPICE Trial.
abstract: BACKGROUND
  The impact of right ventricular (RV) lead location on clinical end points in patients undergoing cardiac resynchronization therapy (CRT) is unclear. We evaluated the impact of different RV lead locations on clinical outcome in CRT patients enrolled in the Septal Positioning of ventricular implantable cardioverter-defibrillator (ICD) Electrodes (SPICE) trial, which randomized recipients of implantable cardioverter defibrillators to apical versus midseptal RV lead positioning.
  
  
  METHODS
  Ninety-eight CRT recipients were included in the multicenter SPICE trial and followed for 12 months: Fifty-three patients were randomized to receive an apical (A) and 45 to receive a midseptal (S) lead position. We compared echocardiographical and electrocardiographical parameters and outcome.
  
  
  RESULTS
  Echocardiographic response with respect to improvement of left ventricular ejection fraction (A: +15.8 ± 14.6%, S: +9.7 ± 12.6%, P = 0.156) and reduction of left ventricular end-diastolic diameter (A: -4.2 ± 10.7 mm, S: -7.5 ± 10.7 mm, P = 0.141) was comparable in apical and midseptal groups. Paced QRS width neither differed at prehospital discharge (A: 129 ± 21 ms, S: 135 ± 21 ms, P = 0.133) nor at 12-month follow-up (A: 131 ± 23 ms, S: 134 ± 28 ms, P = 0.620). No differences were found with respect to the risk of ventricular tachyarrhythmia or ICD therapy. Septal RV lead position, however, was associated with a significant longer time to a first heart failure event (P = 0.040) and a longer survival time (P = 0.019).
  
  
  CONCLUSIONS
  In CRT recipients, midseptal RV lead position was not superior with respect to improvement of echocardiographic parameters or paced QRS width. It did not predispose to ventricular arrhythmias or ICD therapy. The finding that midseptal lead position was associated with a longer time to first heart failure event and a longer survival time deserves further investigation.
authors.affiliation: Cardiology and Angiology I, University Heart Center, Freiburg, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Asbach
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Carsten
authors.initials: C
authors.lastname: Lennerz
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Semmler
authors.affiliation: Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Grebmer
authors.affiliation: Ostalbklinikum, Abteilung für Innere Medizin II, Aalen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Solzbach
authors.affiliation: Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Medizinische Klinik II, Ruhr Universität Bochum, Bochum, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Kloppe
authors.affiliation: Abteilung für Kardiologie und Angiologie, Universitaetsklinikum Leipzig, Leipzig, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Klein
authors.affiliation: Kliniken Maria Hilf, Klinik für Kardiologie, Mönchengladbach, Germany.
authors.forename: Istvan
authors.initials: I
authors.lastname: Szendey
authors.affiliation: Department of Cardiology, Henry Dunant Hospital, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Andrikopoulos
authors.affiliation: Department of Cardiology, Henry Dunant Hospital, Athens, Greece.
authors.forename: Stylianos
authors.initials: S
authors.lastname: Tzeis
authors.affiliation: Cardiology and Angiology I, University Heart Center, Freiburg, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Bode
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
mesh_terms: D000368:Aged; D017147:Defibrillators, Implantable; D004452:Echocardiography; D004567:Electrodes, Implanted; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D019919:Prosthesis Implantation / Q000379:methods; D013318:Stroke Volume; D016896:Treatment Outcome; D014481:United States; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging* / Q000517:prevention & control*
keywords: arrhythmias; cardiac resynchronization therapy; heart failure; right ventricular lead position