Effect of right ventricular lead location on response to cardiac resynchronization therapy in patients with end-stage heart failure

Haghjoo, Majid; Bonakdar, Hamid Reza; Jorat, Mohammad Vahid; Fazelifar, Amir Farjam; Alizadeh, Abolfath; Ojaghi-Haghjghi, Zahra; Esmaielzadeh, Maryam; Sadr‐Ameli, Mohammad Ali

doi:10.1093/europace/eun375

Cited by 42 publications

(21 citation statements)

References 22 publications

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“…Apical or nonapical RV lead placement may derive maximal clinical benefit if a particular LV lead position is achieved, to create maximal lead separation. Apical RV and nonapical RV lead positions have been associated with better outcome when they were stimulated in the presence of anterolateral and posterolateral LV leads, respectively . Included studies used different LV lead locations.…”

Section: Discussionmentioning

confidence: 99%

Clinical and echocardiographic response of apical vs nonapical right ventricular lead position in CRT: A meta‐analysis

Sharma

Dahal

Dominic

et al. 2018

Journal of Arrhythmia

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BackgroundTraditionally the right ventricular (RV) pacing lead is placed in the RV apex in cardiac resynchronization therapy (CRT). It is not clear whether nonapical placement of the RV lead is associated with a better response to CRT. We aimed to perform a meta‐analysis of all randomized controlled trials (RCTs) that compared apical and nonapical RV lead placement in CRT.MethodsWe searched PubMed, EMBASE, Cochrane, Scopus, and relevant references for studies and performed meta‐analysis using random effects model. Our main outcome measures were all‐cause mortality, composite of death and heart failure hospitalization, improvement in ejection fraction (EF), left ventricle end‐diastolic volume (LVEDV), left ventricle end‐systolic volume (LVESV), and adverse events.ResultsSeven RCTs with a total population of 1641 patients (1199 apical and 492 nonapical) were included in our meta‐analysis. There was no difference in all‐cause mortality (5% vs 4.3%, odds ratio (OR) = 0.86; 95% confidence interval (CI) 0.45‐1.64; P = .65; I 2 = 11%) and a composite of death and heart failure hospitalization (14.2% vs 12.9%, OR = 0.92; 95% CI: 0.61‐1.38; P = .68; I 2 = 0) between apical and nonapical groups. No difference in improvement in EF (Weighted mean difference (WMD) = 0.37; 95% CI: −2.75‐3.48; P = .82; I 2 = 68%), change in LVEDV (WMD = 3.67; 95% CI: −4.86‐12.20; P = .40; I 2 = 89%) and LVESV (WMD = −1.20; 95% CI: −4.32‐1.91; P = .45; I 2 = 0) were noted between apical and nonapical groups. Proportion of patients achieving >15% improvement in EF was similar in both groups (OR = 0.85; 95% CI: 0.62‐1.16; P = .31; I 2 = 0).ConclusionIn patients with CRT, nonapical RV pacing is not associated with improved clinical and echocardiographic outcomes compared with RV apical pacing.

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Section: Discussionmentioning

confidence: 99%

Clinical and echocardiographic response of apical vs nonapical right ventricular lead position in CRT: A meta‐analysis

Sharma

Dahal

Dominic

et al. 2018

Journal of Arrhythmia

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“…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%

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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“…[9-12] Alternate RV lead position in CRT has demonstrated similar hemodynamic effects as RV-A in previous studies. [13-16] However, there are few data concerning long-term electrophysiological stability and associated complications in alternate RV pacing sites in CRT.…”

Section: Introductionmentioning

confidence: 99%

Right Ventricular Pacing and Sensing Function in High Posterior Septal and Apical Lead Placement in Cardiac Resynchronization Therapy

Kristiansen

Hovstad

Vollan

et al. 2012

Indian Pacing and Electrophysiology Journal

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BackgroundThe conventional right ventricular (RV) lead position in cardiac resynchronization therapy pacemakers (CRT-P) is the RV apex (RV-A). Little is known about electrophysiological stability and associated complications of pacing leads in RV high posterior septal (RV-HS) position in CRT-P.MethodsTwo hundred and thirty-five consecutive CRT-P patients were included from 1999-2010. Pacing thresholds at 0.5ms and 2.5V, sensing electrograms and lead impedances were measured at implant and repeated 1,3,6,12,18 and 24 months after CRT-P. Electrophysiological measurements of leads located in RV-A and RV-HS were analyzed retrospectively. Bipolar RV leads were used, including high impedance leads, passive fixation and active fixation.ResultsRV pacing leads were implanted in RV-A (n=79) and RV-HS (n=156). Average RV pacing thresholds from CRT implant procedure to 24-month follow-up at 0.5ms were 0.77±0.69V in RV-A and 0.71±0.35V in RV-HS (P=0.31), and at 2.5V were 0.06±0.08ms in RV-A and 0.07±0.05ms in RV-HS (P=0.12). Average RV electrogram amplitudes from baseline to 24 months after CRT were 15.3±6.9mV in RV-A and 12.1±6.0mV in RV-HS (P=0.55). Average RV impedances during follow-up were 850±286Ω in RV-A and 618±147Ω in RV-HS (P=0.57). Similar RV lead revisions between RV-A and RV-HS were observed after 2-year follow-up (P=0.55).ConclusionThe RV-HS lead position demonstrated stable and acceptable long-term pacing and sensing function, with rates of complications comparable to conventional RV-A lead position in CRT. The RV-HS lead position is feasible in CRT-P.

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Effect of right ventricular lead location on response to cardiac resynchronization therapy in patients with end-stage heart failure

Abstract: The present study did not show any difference between RVA and RVHS pacing sites in terms of overall improvement in clinical outcome and LV reverse remodelling following CRT. However, effect of RV lead location on CRT response varies depending on LV stimulation site.

Cited by 42 publications

References 22 publications

Clinical and echocardiographic response of apical vs nonapical right ventricular lead position in CRT: A meta‐analysis

Clinical and echocardiographic response of apical vs nonapical right ventricular lead position in CRT: A meta‐analysis

Influence of Pacing Site Characteristics on Response to Cardiac Resynchronization Therapy

Right Ventricular Pacing and Sensing Function in High Posterior Septal and Apical Lead Placement in Cardiac Resynchronization Therapy

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