Does RV Lead Positioning Provide Additional Benefit to Cardiac Resynchronization Therapy in Patients with Advanced Heart Failure?

Abstract

RVHS stimulation has no overall advantage as an alternative stimulation site for RVA during BiV pacing. RVHS was equivalent with RVA in combination with the PL LV site, while RVA was superior to RVHS in combination with AL or LAT LV site.

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

“…Our results differ from those of Shimano [14] who found that RV apical pacing conferred benefit in combination with an anterolateral and lateral LV lead over an RV septal lead position. However, nearly all the patients (29/31) had DCM, and it would appear that the extent and position of myocardial scar affects the acute and chronic response to CRT.…”

“…Single-site RV pacing outflow tract and/or septal pacing have been associated with acute hemodynamic response [32,33] and reduced wall motion abnormalities compared with apical position [34]. Shimano [14] and Hay [35] both found limited influence on the AHR of RV stimulation site during BIV pacing. Leclercq [36] defined optimal BIV pacing mode by the degree of QRS narrowing and found that BIV pacing with the RV lead inserted in the RV outflow tract was superior in 11 patients (69%) and in the RV apex in seven patients (39%).…”

“…Previous studies examining the effect of the RV lead position in CRT have found conflicting results [14][15][16]. No study has investigated the effect of myocardial scar in relation to RV lead position and response to CRT.…”

Impact of a Single Intracoronary Administration of Adiponectin on Myocardial Ischemia/Reperfusion Injury in Pig Model

“…Data were processed with Power Laboratory recording and analysis software (AD Instruments, Oxfordshire, UK) as described previously. 18 Then, using a 6F guiding catheter, we performed coronary angiography to determine the optimal location of the occlusion and assessment of coronary artery size after administration of nitroglycerine (0.2 mg). Depending on the visual estimate of vessel size, an over-the-wire-type angioplasty balloon catheter (diameter, 3.0±0.5 mm; length, 18 mm; Boston Scientific Japan, Tokyo, Japan) was placed in the left anterior descending artery (LAD) distal to the first major diagonal branch.…”

Intraprocedural Assessment of Stimulation, Sensing, Detection, and Defibrillation

“…36,[40][41][42][43] RV lead positioning may also important for CRT response, but the evidence for this is inconclusive.…”