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Apical LV lead placement may worsen CRT outcomes
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Apical left ventricular placement was associated with worse cardiac resynchronization therapy outcomes than placement in basal/midventricle segments, according to study findings.
“A number of studies have suggested that preferential targeting of LV leads to the lateral or posterolateral coronary sinus branches improves outcomes. However, little is known about the impact of longitudinal LV lead position,” the researchers wrote.
The researchers from Massachusetts General Hospital and Harvard Medical School retrospectively examined patients’ (n=115) coronary sinus venograms and chest X-rays to determine segmental LV lead placement along the longitudinal axis (apical, midventricle or basal).
The patients were divided into two groups based on LV lead position: apical (n=25) and basal/midventricle (n=90). The apical group was older (72.9 years vs. 66.5 years; P=.01) and more likely to have ischemic cardiomyopathy (77% vs. 52%; P<.001). The primary outcome was combined endpoint of HF hospitalization, cardiac transplantation or all-cause mortality.
During a mean follow-up of 15.1 ± 9 months, event-free survival was lower in the apical group (52% vs. 79%, P=.006), and analysis of the individual components of the primary endpoint indicated that patients with apical LV leads had a higher mortality rate (16% vs. 1%, P=.008). The apical group also experienced less improvement in NYHA functional class and less LV reverse remodeling, according to the researchers.
“This study is novel and hypothesis-generating, but it alone cannot alter practice,” the researchers wrote. “Until there are prospective, randomized data that confirm the deleterious impact of apical lead placement, we recommend that electrophysiologists strive for the most stable radiographic location possible.”
Merchant F . Heart Rhythm. 2010;7:639-644.