Adverse response to cardiac resynchronisation therapy in patients with septal scar on cardiac MRI preventing a septal right ventricular lead position

Duckett, Simon; Ginks, Matthew; Shetty, Anoop; Kirubakaran, Senthil; Bostock, Julian; Kapetanakis, Stam; Gill, Jaswinder; Carr‐White, Gerry; Razavi, Reza; Rinaldi, Christopher Aldo

doi:10.1007/s10840-011-9630-9

Cited by 17 publications

(9 citation statements)

References 42 publications

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“…The potential relevance of RV pacing region scar was highlighted in a recent study by Duckett et al 24 that evaluated the feasibility of achieving a midseptal RV pacing position among 50 consecutive patients receiving CRT. In this study, a more conventional apical position was conceded to in those patients with poor R-wave pacing amplitudes (≤5 mV) and identified that these patients had a 67% prevalence of septal scar by LGE imaging versus 33% in those where adequate voltages were achieved.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, the concept of midseptal or RV outflow tract pacing has been shown to be both feasible [39][40][41][42] and potentially of clinical value. 24,42 In a study by Haghjoo et al, 40 patients otherwise receiving optimal LV pacing (ie, those with LV leads delivered to the posterolateral wall) had significantly higher CRT response rates when the RV lead was placed to the high (basal) septum compared with conventional apical placement (70% versus 30%; P=0.01). Furthermore, Duckett et al 24 showed that midseptal pacing was associated with improved response rate compared with apical pacing (70% versus 30%; P=0.01).…”

Section: Discussionmentioning

confidence: 99%

“…[20][21][22] Preliminary evidence similarly suggests absence of RV pacing region (ie, septal wall) scar to be of importance for achieving response. 23,24 However, the relative and combined influence of these variables on response to CRT has not been well studied.…”

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confidence: 99%

See 2 more Smart Citations

Influence of Pacing Site Characteristics on Response to Cardiac Resynchronization Therapy

Wong¹,

Yee²,

Stirrat³

et al. 2013

Circ: Cardiovascular Imaging

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screened for study eligibility. Inclusion criteria were the following:Background-Transmural scar occupying left ventricular (LV) pacing regions has been associated with reduced response to cardiac resynchronization therapy (CRT). However, spatial influences of lead tip delivery relative to scar at both pacing sites remain poorly explored. This study evaluated scar distribution relative to LV and right ventricular (RV) lead tip placement through coregistration of late gadolinium enhancement MRI and cardiac computed tomographic (CT) findings. Influences on CRT response were assessed by serial echocardiography. Methods and Results-Sixty patients receiving CRT underwent preimplant late gadolinium enhancement MRI, postimplant cardiac CT, and serial echocardiography. Blinded segmental evaluations of mechanical delay, percentage scar burden, and lead tip location were performed. Response to CRT was defined as a reduction in LV end-systolic volume ≥15% at 6 months. The mean age and LV ejection fraction were 64±9 years and 25±7%, respectively. Mean scar volume was higher among CRT nonresponders for both the LV (23±23% versus 8±14% [P=0.01]) and RV pacing regions (40±32% versus 24±30% [P=0.04]). Significant pacing region scar was identified in 13% of LV pacing regions and 37% of RV pacing regions. Absence of scar in both regions was associated with an 81% response rate compared with 55%, 25%, and 0%, respectively, when the RV, LV, or both pacing regions contained scar. LV pacing region dyssynchrony was not predictive of response. Conclusions-Myocardial scar occupying the LV pacing region is associated with nonresponse to CRT. Scar occupying the RV pacing region is encountered at higher frequency and seems to provide a more intermediate influence on CRT response. (Circ Cardiovasc Imaging. 2013;6:542-550.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Influence of Pacing Site Characteristics on Response to Cardiac Resynchronization Therapy

Wong¹,

Yee²,

Stirrat³

et al. 2013

Circ: Cardiovascular Imaging

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“…20,22,38 The most recently published study by Wong et al 22 showed that transmural scar was 3 times more prevalent in the RV versus LV pacing region, being seen in one-third of CRT patients. This study found that the delivery of both pacing leads to nonscarred regions resulted in an 82% response rate versus 55% if the RV pacing site was scarred, 25% if the LV site was scarred, and 0% if both were scarred.…”

Section: Discussionmentioning

confidence: 99%

“…This study found that the delivery of both pacing leads to nonscarred regions resulted in an 82% response rate versus 55% if the RV pacing site was scarred, 25% if the LV site was scarred, and 0% if both were scarred. While focused on basal RV septal lead placement, a small cohort study by Duckett et al 38 suggested that targeted placement of the RV lead to nonscarred basal septal segments was associated with greater response to CRT. This finding was in contrast to patients paced from a transmurally scarred RV apical segment who experienced a 36% absolute reduction in clinical response.…”

Section: Discussionmentioning

confidence: 99%

Model-Based Navigation of Left and Right Ventricular Leads to Optimal Targets for Cardiac Resynchronization Therapy

Laksman

Yee

Stirrat

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Left ventricular (LV) and right ventricular pacing site characteristics have been shown to influence response to cardiac resynchronization therapy (CRT). This study aimed to determine the clinical feasibility of image-guided lead delivery using a 3-dimensional navigational model displaying both LV and right ventricular (RV) pacing targets. Serial echocardiographic measures of clinical response and procedural metrics were evaluated. Methods and Results-Thirty-one consecutive patients underwent preimplant cardiac MRI with the generation of a 3-dimensional navigational model depicting optimal segmental targets for LV and RV leads. Lead delivery was guided by the model in matched views to intraprocedural fluoroscopy. Blinded assessment of final lead tip location was performed from postprocedural cardiac computed tomography. Clinical and LV remodeling response criteria were assessed at baseline, 3 months, and 6 months using a 6-minute hall walk, quality of life questionnaire, and echocardiography. Mean age and LV ejection fraction was 66±8 years and 26±8%, respectively. LV leads were successfully delivered to a target or adjacent segment in 30 of 31 patients (97%), 68% being nonposterolateral. RV leads were delivered to a target or adjacent segment in 30 of 31 patients (97%), 26% being nonapical. Twenty-three patients (74%) met standard criteria for response (LV end-systolic volume reduction ≥15%), 18 patients (58%) for super-response (LV end-systolic volume reduction ≥30%). LV ejection fraction improved at 6 months (31±8 versus 26±8%, P=0.04). Conclusions-This study demonstrates clinical feasibility of dual cardiac resynchronization therapy lead delivery to optimal targets using a 3-dimensional navigational model. High procedural success, acceptable procedural times, and a low rate of early procedural complications were observed. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01640769.

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Lead Position Evaluation in Patients with Implanted Devices

Toader

2024

Echocardiographic Evaluation of Patients With Implanted Devices

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Adverse response to cardiac resynchronisation therapy in patients with septal scar on cardiac MRI preventing a septal right ventricular lead position

Abstract: The presence of septal scar was associated with a poor acute and chronic response to CRT. This may relate to the inability to achieve a RV septal lead placement.

Cited by 17 publications

References 42 publications

Influence of Pacing Site Characteristics on Response to Cardiac Resynchronization Therapy

Influence of Pacing Site Characteristics on Response to Cardiac Resynchronization Therapy

Model-Based Navigation of Left and Right Ventricular Leads to Optimal Targets for Cardiac Resynchronization Therapy

Lead Position Evaluation in Patients with Implanted Devices

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