Cited by 379Cardiac pacing and defibrillation studiesCardiac Structural Anomalies and RepairCardiac Arrest and Resuscitation

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Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization Therapy

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Ypenburg, Claudia, van Bommel, Rutger J., Delgado, Victoria, Mollema, Sjoerd A., Bleeker, Gabe B., Boersma, Eric, Schalij, Martin J., Bax, Jeroen J.·2008·Journal of the American College of Cardiology

DOI 10.1016/j.jacc.2008.06.046

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Abstract

Objectives The aim of the current study was to evaluate echocardiographic parameters after 6 months of cardiac resynchronization therapy (CRT) as well as long-term outcome in patients with the left ventricular (LV) lead positioned at the site of latest activation (concordant LV lead position) as compared with that seen in patients with a discordant LV lead position.Background A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT.Methods The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest X-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure.Results Significant LV reverse remodeling (reduction in LV end-systolic volume from 189 +/- 83 ml to 134 +/- 71 ml, p < 0.001) was noted in the group of patients with a concordant LV lead position (n = 153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32 +/- 16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, p = 0.004).Conclusions Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up.

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“CRT aims to restore this dyssynchronous activation and the location of the left ventricular (LV) pacing lead has repeatedly been identified as an important contributor to patient response (Singh et al., 2011; Ypenburg et al., 2008).”
The Effect of Left Ventricular Electrical Delay on the Acute Hemodynamic Response with Cardiac Resynchronization Therapy
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“With respect to relative improvement in LVESV, previous studies indicate that 55% (range 44%–62%) of subjects achieve an improvement of at least 15%.(6,7,20,23,36,46) In the MADIT-CRT trial,(43) the percentage change in LVESV among defibrillator patients was 10.”
Result
Value of Tissue Doppler Echocardiography in Predicting Response to Cardiac Resynchronization Therapy in Patients With Heart Failure
van Bommel, R. J., Ypenburg, C., Borleffs, C. J. W., Delgado, V., Marsan, N. A., Bertini, M., Holman, E. R., Schalij, M. J., & Bax, J. J. (2010) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2009.12.018 · Cited by 32
Self-citation
Left ventricular systolic and diastolic dyssynchrony assessed by phase analysis of gated SPECT myocardial perfusion imaging: a comparison with speckle tracking echocardiography
Hsu, T. H., Huang, W., Chen, C., Hung, G., Chen, T.-C., Kao, C., & Chen, J. (2013) · Annals of Nuclear Medicine · doi:10.1007/s12149-013-0744-2 · Cited by 32
“Moreover, TDE systolic dyssynchrony assessment has been shown to identify the sites of latest activation as the optimal positions of the LV pacing leads for cardiac resynchronization therapy [22, 23].”
Background
The Year in Echocardiography
Weyman, A. E. (2009) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2009.01.042 · Cited by 32
“(5) followed up 257 patients for a ean of 32 months after CRT.”
Background
Quadripolar Leads in Cardiac Resynchronization Therapy
van Everdingen, W. M., Cramer, M. J., Doevendans, P. A., & Meine, M. (2015) · JACC. Clinical electrophysiology · doi:10.1016/j.jacep.2015.07.004 · Cited by 31
The amount of viable and dyssynchronous myocardium is associated with response to cardiac resynchronization therapy: initial clinical results using multiparametric ECG-gated [18F]FDG PET
Lehner, S., Uebleis, C., Schüßler, F., Haug, A. R., Kääb, S., Bartenstein, P., Kriekinge, S. D. V., Germano, G., Estner, H., & Hacker, M. (2013) · European Journal of Nuclear Medicine and Molecular Imaging · doi:10.1007/s00259-013-2516-6 · Cited by 30
“It has been demonstrated that an LV lead position outside the area of latest mechanical contraction activation is associated with a lower response rate [23] and even with a shorter long-term survival of the patients [24].”
Background
Biophysical Modeling to Determine the Optimization of Left Ventricular Pacing Site and AV/VV Delays in the Acute and Chronic Phase of Cardiac Resynchronization Therapy
Lee, A., Crozier, A., Hyde, E., Lamata, P., Truong, M. V. N., Sohal, M., Jackson, T., Behar, J. M., Claridge, S., Shetty, A., et al. (2016) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.13134 · Cited by 31
4D cardiac electromechanical activation imaging
Grondin, J., Wang, D., Grubb, C. S., Trayanova, N. A., & Konofagou, E. E. (2019) · Computers in Biology and Medicine · doi:10.1016/j.compbiomed.2019.103382 · Cited by 31
Anodal stimulation: an underrecognized cause of nonresponders to cardiac resynchronization therapy.
Dendy, K. F., Powell, B. D., Cha, Y., Espinosa, R. E., Friedman, P. A., Rea, R. F., Hayes, D. L., Redfield, M. M., & Asirvatham, S. J. (2011) · Europe PMC (PubMed Central) · Cited by 30
Apical rocking is predictive of response to cardiac resynchronization therapy
Ghani, A., Delnoy, P. P. H., Ottervanger, J. P., Misier, A. R. R., Smit, J. J. J., Adiyaman, A., & Elvan, A. (2015) · International journal of cardiac imaging · doi:10.1007/s10554-015-0607-0 · Cited by 30
“Echocardiographic response to CRT was defined as a reduction of C15 % in LVESV compared to baseline echocardiographic measurement, at the second year of echocardiographic follow up [18, 19].”
BackgroundMethod
Impact of left ventricular lead position on the incidence of ventricular arrhythmia and clinical outcome in patients with cardiac resynchronization therapy
Kleemann, T., Becker, T., Strauss, M., Dyck, N., Schneider, S., Weisse, U., Saggau, W., Cornelius, B., Layer, G., & Seidl, K. (2010) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-010-9470-z · Cited by 29
“As the LV pacing site is strongly related to the outcome of reverse modeling in patients receiving CRT [15, 16, 18], there might be an influence of the LV lead position on the occurrence of malignant arrhythmia.”
Background
Empiric versus imaging guided left ventricular lead placement in cardiac resynchronization therapy (ImagingCRT): study protocol for a randomized controlled trial
Sommer, A., Kronborg, M. B., Poulsen, S. H., Bøttcher, M., Nørgaard, B. L., Bouchelouche, K., Mortensen, P. T., Gerdes, C., & Nielsen, J. C. (2013) · Trials · doi:10.1186/1745-6215-14-113 · Cited by 29
Phrenic stimulation management in CRT patients: are we there yet?
Biffi, M., & Boriani, G. (2010) · Current Opinion in Cardiology · doi:10.1097/hco.0b013e3283413838 · Cited by 28
Cardiac Resynchronization Therapy Optimization Using Noninvasive Cardiac Output Measurement
Khan, F. Z., Virdee, M., HUTCHINSON, J., SMITH, B., Pugh, P. J., Read, P. A., Fynn, S. P., & Dutka, D. P. (2011) · Pacing and Clinical Electrophysiology · doi:10.1111/j.1540-8159.2011.03172.x · Cited by 28

Authors: Ypenburg, C., van Bommel, R. J., Delgado, V., Mollema, S. A., Bleeker, G. B., Boersma, E., Schalij, M. J., & Bax, J. J.
Affiliations: Leiden University Medical Center (NL)
Erasmus University Rotterdam (NL)
Corresponding author: Bax, Jeroen J.
ORCID: Delgado, Victoria
Boersma, Eric
Schalij, Martin J.
Bax, Jeroen J.
Venue: Journal of the American College of Cardiology
Publisher: Elsevier BV
Published: 2008-10
Volume: 52
Issue: 17
Pages: 1402-1409
ISSN: 0735-1097 (ISSN-L)
DOI: 10.1016/j.jacc.2008.06.046
OpenAlex: W2159040286
Cited by: 379
References: 38
Citations by year: 2026: 7 · 2025: 2 · 2024: 2 · 2023: 1 · 2022: 4 · 2021: 12 · 2020: 12 · 2019: 14 · 2018: 11 · 2017: 19 · 2016: 30 · 2015: 27 · 2014: 35 · 2013: 35 · 2012: 31
FWCI: 32.96
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 1749 d)
Locations: Journal of the American College of Cardiology (publishedVersion)
PubMed (publishedVersion)
EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
Funders: Boston Scientific Corporation
European Society of Cardiology
Topics: Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
Health Sciences › Medicine › Surgery › Cardiac Structural Anomalies and Repair
Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
Keywords: cardiac resynchronization therapy, left ventricular lead position, reverse remodeling, heart failure hospitalization, all-cause mortality, CRT response, echocardiographic response
MeSH terms: Aged, Cardiac Pacing, Artificial, Electrodes, Implanted, Female, Forecasting, Heart Failure, Heart Ventricles, Humans, Male, Middle Aged, Pacemaker, Artificial, Severity of Illness Index, Stroke Volume, Time Factors, Echocardiography, Doppler, Survival Analysis, Treatment Outcome, Ventricular Remodeling

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Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization Therapy

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