Impact of the Right Ventricular Lead Position on Clinical End Points in CRT Recipients—A Subanalysis of the Multicenter Randomized SPICE Trial

Asbach, Stefan; Lennerz, Carsten; Semmler, Verena; Grebmer, Christian; Solzbach, U.; Kloppe, Axel; Klein, N.; Szendey, Istvan; Andrikopoulos, George; Tzeis, Stylianos; Bode, Christoph; Kolb, Christof

doi:10.1111/pace.12793

Cited by 10 publications

(11 citation statements)

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“…Although majority of MES‐guided pacing occurred in nonapical sites, the greatest MES was found in RV apex in some patients. All the studies had biventricular lead placement except for 2 patients in the study by Asbach et al who were excluded from the final analysis. Left ventricular lead position was provided in all studies except for the study by Asbach et al.…”

Section: Resultsmentioning

confidence: 73%

“…We retrieved 82 citations from electronic database and manual searches as shown in Figure . We reviewed 16 citations for full‐text articles; 7 full‐text articles were included in the final analysis . Four of the included studies were post hoc analyses of the RCTs and one was randomized crossover trial .…”

Section: Resultsmentioning

confidence: 99%

“…All the studies had biventricular lead placement except for 2 patients in the study by Asbach et al who were excluded from the final analysis. Left ventricular lead position was provided in all studies except for the study by Asbach et al. LV lead positions were variable across the studies.…”

Section: Resultsmentioning

confidence: 99%

“…We reviewed 16 citations for fulltext articles; 7 full-text articles were included in the final analysis. [17][18][19][20][21][22][23] Four of the included studies were post hoc analyses of the RCTs [19][20][21][22] and one was randomized crossover trial. 21 All the included studies were published between 2011 and 2016.…”

Section: Description Of Individual Studiesmentioning

confidence: 99%

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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: Resultsmentioning

confidence: 73%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Description Of Individual Studiesmentioning

confidence: 99%

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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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“…The interlead distance may also be maximised by placing the RV lead as far away as possible from a presumed optimal LV lead position. However, conflicting results have been reported concerning the importance of the RV lead position and we did not investigate the impact of an RV lead repositioning based on the choice of active LV electrode 22…”

Section: Discussionmentioning

confidence: 99%

Contractility surrogates derived from three-dimensional lead motion analysis and prediction of acute haemodynamic response to CRT

et al. 2018

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BackgroundPatient-specific left ventricular (LV) lead optimisation strategies with immediate feedback on cardiac resynchronisation therapy (CRT) effectiveness are needed. The purpose of this study was to compare contractility surrogates derived from biventricular lead motion analysis to the peak positive time derivative of LV pressure (dP/dtmax) in patients undergoing CRT implantation.MethodsTwenty-seven patients underwent CRT implantation with continuous haemodynamic monitoring. The right ventricular (RV) lead was placed in apex and a quadripolar LV lead was placed laterally. Biplane fluoroscopy cine films facilitated construction of three-dimensional RV–LV interlead distance waveforms at baseline and under biventricular pacing (BIVP) from which the following contractility surrogates were derived; fractional shortening (FS), time to peak systolic contraction and peak shortening of the interlead distance (negative slope). Acute haemodynamic CRT response was defined as LV ∆dP/dtmax ≥ 10 %.ResultsWe observed a mean increase in dP/dtmax under BIVP (899±205 mm Hg/s vs 777±180 mm Hg/s, p<0.001). Based on ΔdP/dtmax, 18 patients were classified as acute CRT responders and nine as non-responders (23.3%±10.6% vs 1.9±5.3%, p<0.001). The baseline RV–LV interlead distance was associated with echocardiographic LV dimensions (end diastole: R=0.61, p=0.001 and end systole: R=0.54, p=0.004). However, none of the contractility surrogates could discriminate between the acute CRT responders and non-responders (ΔFS: −2.5±2.6% vs − 2.0±3.1%, p=0.50; Δtime to peak systolic contraction: −9.7±18.1% vs −10.8±15.1%, p=0.43 and Δpeak negative slope: −8.7±45.9% vs 12.5±54.8 %, p=0.09).ConclusionThe baseline RV–LV interlead distance was associated with echocardiographic LV dimensions. In CRT recipients, contractility surrogates derived from the RV–LV interlead distance waveform could not discriminate between acute haemodynamic responders and non-responders.

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Baseline clinical characteristics of heart failure patients with reduced ejection fraction enrolled in the BUDAPEST‐CRT Upgrade trial

Merkely

Gellér

Zima

et al. 2022

European J of Heart Fail

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AimsThe BUDAPEST-CRT Upgrade study is the first prospective, randomized, multicentre clinical trial investigating the outcomes after cardiac resynchronization therapy (CRT) upgrade in heart failure (HF) patients with intermittent or permanent right ventricular pacing (RVP) with wide paced QRS. This report describes the baseline clinical characteristics of the enrolled patients and compares them to cohorts from previous milestone CRT studies. Methods and ResultsThis international multicentre randomized controlled trial investigates 360 patients having a pacemaker (PM) or implantable cardioverter defibrillator (ICD) device for at least six months prior to enrollment, reduced left ventricular ejection fraction (LVEF≤35%), HF symptoms (New York Heart Association functional class II-IVa), wide paced QRS (>150 ms), and ≥20% of RVP burden without having a native left bundle branch block.At enrollment, the mean age of the patients was 73±8 years; 89% were male, 97% of the patients were in NYHA II/III functional class, and 56% had atrial fibrillation. Enrolled patients predominantly had conventional PM devices, with a mean RVP burden of 86%.Thus, this is a patient cohort with advanced HF, low baseline LVEF (25%±7%), high Nterminal pro-B-type natriuretic peptide (NT-proBNP) levels [2231 pg/mL (25th -75th percentile 1254/4309 pg/mL)], and frequent HF hospitalizations during the preceding 12 months (50%). ConclusionWhen compared with prior CRT trial cohorts, the BUDAPEST-CRT Upgrade study includes older patients with a strong male predominance and a high burden of atrial fibrillation and other comorbidities. Moreover, this cohort represents an advanced HF population with low LVEFs, high NT-proBNPs, and frequent previous HF events.

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Impact of the Right Ventricular Lead Position on Clinical End Points in CRT Recipients—A Subanalysis of the Multicenter Randomized SPICE Trial

Cited by 10 publications

References 20 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

Contractility surrogates derived from three-dimensional lead motion analysis and prediction of acute haemodynamic response to CRT

Baseline clinical characteristics of heart failure patients with reduced ejection fraction enrolled in the BUDAPEST‐CRT Upgrade trial

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