The Clinical, Electrocardiographic, and Echocardiographic Outcomes of Posterolateral vs Anterolateral Lead Position in Patients With Nonischemic Cardiomyopathy Receiving Cardiac Resynchronization Therapy

Document Type : Original Article

Authors

1 Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, IR Iran.

2 School of Medicine, Azad University of Medical Sciences, Tehran, IR Iran.

Abstract

Background: Cardiac resynchronization therapy (CRT) is a safe and effective method to treat heart failure (HF) in selected patients after failed medical therapy. We aimed to compare the effects of left ventricular (LV) lead position on the clinical, electrocardiographic (ECG), and echocardiographic parameters in patients with nonischemic cardiomyopathy (NICM) considering the absence of a large regional scar.
 
Methods: Thirty consecutive patients with NICM referred to the Imam Khomeini Hospital Complex for CRT implantation were enrolled in this study. Clinical, ECG, and echocardiographic parameters at baseline and 6 months of follow-up in patients whose left ventricular lead (LV) was implanted in the anterolateral (AL) vs posterolateral (PL) branch of the coronary sinus were compared.
 
Results: The majority of the patients were women (16, 53%). In both groups, functional class improved significantly after CRT implantation, but this decrease was not related to the position of the LV lead. The QRS width in ECG was significantly reduced in the AL group after CRT implantation (from 157.7: 95% CI, 156.13 to 158.27 to 137.3: 95% CI, 133.37 to 141.24; P =0.000). This decrease was also seen in the PL group (from 157.6: 95% CI, 154.26 to 160.01 to 137.6: 95% CI, 133.46 to 141.84; P =0.000), but the decrease was not related to the LV lead position.
 
Conclusions: Our data showed no significant differences in clinical, ECG, or echocardiographic outcomes between PL and AL lead positions in patients receiving CRT. (Iranian Heart Journal 2023; 24(3): 70-76)

Keywords

References

  1. Ziaeian B, Fonarow GC. Epidemiology and aetiology of heart failure. Nature reviews Cardiology 2016; 13(6): 368-78.
  2. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European Heart Journal 2016; 37(27): 2129-200.
  3. Dokuni K, Matsumoto K, Tatsumi K, et al. Cardiac resynchronization therapy improves left atrial reservoir function through resynchronization of the left atrium in patients with heart failure with reduced ejection fraction. The international journal of cardiovascular imaging 2020: 1-10.
  4. Abraham WT, Fisher WG, Smith AL, et al. Cardiac resynchronization in chronic heart failure. The New England journal of medicine 2002; 346(24): 1845-53.
  5. Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Journal of the American College of Cardiology 2022; 79(17): e263-e421.
  6. Butter C, Auricchio A, Stellbrink C, et al. Effect of resynchronization therapy stimulation site on the systolic function of heart failure patients. Circulation 2001; 104(25): 3026-9.
  7. Bleeker GB, Kaandorp TA, Lamb HJ, et al. Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation 2006; 113(7): 969-76.
  8. Sassone B, Nucifora G, Mele D, Valzania C, Bisignani G, Boriani G. Role of cardiovascular imaging in cardiac resynchronization therapy: a literature review. J Cardiovasc Med (Hagerstown) 2018; 19(5): 211-22.
  9. Satish P, Narasimhan B, Hagendorff A, Tayal B. Evolving concept of dyssynchrony and its utility. J Geriatr Cardiol 2022; 19(1): 44-51.
  10. Khan FZ, Virdee MS, Palmer CR, et al. Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy: The TARGET Study: A Randomized, Controlled Trial. Journal of the American College of Cardiology 2012; 59(17): 1509-18.
  11. Ansalone G, Giannantoni P, Ricci R, Trambaiolo P, Fedele F, Santini M. Doppler myocardial imaging to evaluate the effectiveness of pacing sites in patients receiving biventricular pacing. Journal of the American College of Cardiology 2002; 39(3): 489-99.
  12. Wong JA, Yee R, Stirrat J, et al. Influence of pacing site characteristics on response to cardiac resynchronization therapy. Circ Cardiovasc Imaging 2013; 6(4): 542-50.
  13. Mollazadeh R, Eftekhari MR, Eslami M. Efficacy of Intravenous Acetaminophen in Periimplantation Pain of Cardiac Electronic Devices: A Randomized Double-Blinded Study. Journal of PeriAnesthesia Nursing 2017; 32(3): 215-8.
  14. Dekker A, Phelps B, Dijkman B, et al. Epicardial left ventricular lead placement for cardiac resynchronization therapy: optimal pace site selection with pressure-volume loops. The Journal of thoracic and cardiovascular surgery 2004; 127(6): 1641-7.
  15. Auricchio A, Fantoni C, Regoli F, et al. Characterization of left ventricular activation in patients with heart failure and left bundle-branch block. Circulation 2004; 109(9): 1133-9.
  16. Kutyifa V, Kosztin A, Klein HU, et al. Left Ventricular Lead Location and Long-Term Outcomes in Cardiac Resynchronization Therapy Patients. JACC: Clinical Electrophysiology 2018; 4(11): 1410-20.
  17. Ypenburg C, van Bommel RJ, Delgado V, et al. Optimal left ventricular lead position predicts reverse remodeling and survival after cardiac resynchronization therapy. Journal of the American College of Cardiology 2008; 52(17): 1402-9.
  18. Khan FZ, Virdee MS, Palmer CR, et al. Targeted left ventricular lead placement to guide cardiac resynchronization therapy: the TARGET study: a randomized, controlled trial. J Am Coll Cardiol 2012; 59(17): 1509-18.
  19. Saba S, Marek J, Schwartzman D, et al. Echocardiography-guided left ventricular lead placement for cardiac resynchronization therapy: results of the Speckle Tracking Assisted Resynchronization Therapy for Electrode Region trial. Circ Heart Fail 2013; 6(3): 427-34.
  20. Dong Y-X, Powell BD, Asirvatham SJ, et al. Left ventricular lead position for cardiac resynchronization: a comprehensive cinegraphic, echocardiographic, clinical, and survival analysis. EP Europace 2012; 14(8): 1139-47.
Iranian Heart Journal
Volume 24, Issue 3
July 2023
Pages 70-76

Files

Share

How to cite

Statistics