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Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization Therapy
Open accessAbstract
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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“The importance of optimal left ventricular lead position was stressed by Ypenburg and coworkers in obtaining benefits from cardiac resynchronization therapy (CRT).18”
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“spective data suggest that response to CRT may be influenced by the location of the left ventricular (LV) lead in relation to the patient’s individual site of latest mechanical LV contraction.(2) We”
BackgroundResponse to Cardiac Resynchronization Therapy as Assessed by Time‐Based Speckle Tracking Imaging
Ghani, A., Delnoy, P. P. H. M., Adiyaman, A., Ottervanger, J. P., Misier, A. R. R., Smit, J. J. J., & Elvan, A. (2015) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.12589 · Cited by 10
Cardiac Resynchronization Therapy in Non-Ischemic Cardiomyopathy.
Shanks, M., Delgado, V., & Bax, J. J. (2016) · PubMed Central · doi:10.4022/jafib.1362 · Cited by 10
Self-citationOptimal pacing sites in cardiac resynchronization by left ventricular activation front analysis
Albatat, M., Arevalo, H., Bergsland, J., Strøm, V. N., Balasingham, I., & Odland, H. H. (2020) · Computers in Biology and Medicine · doi:10.1016/j.compbiomed.2020.104159 · Cited by 10
Clinical Outcomes of Cardiac Resynchronization with Epicardial Left Ventricular Lead
Chen, L., Fu, H., Pretorius, V. G., YANG, D., Wiste, H. J., Yuan, H., Feld, G. K., Cha, Y., & Birgersdotter-Green, U. M. (2015) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.12687 · Cited by 10
Fatemi, M., Gal, G. L., Blanc, J., Mansourati, J., & ETIENNE, Y. (2011) · Cardiology Research and Practice · doi:10.4061/2011/956062 · Cited by 10
Cardiac resynchronisation therapy and the role of optimal device utilisation
Buck, S. D., Maass, A. H., van Veldhuisen, D. J., & Gelder, I. C. V. (2009) · Netherlands Heart Journal · doi:10.1007/bf03086283 · Cited by 10
Wecke, L., van Hunnik, A., Thompson, T., DiCarlo, L. A., Zdeblick, M. J., Auricchio, A., & Prinzen, F. W. (2011) · Heart Rhythm · doi:10.1016/j.hrthm.2011.11.052 · Cited by 9
Speckle tracking echocardiography: clinical applications in cardiac resynchronization therapy.
Zhang, X., Si, H., Wang, X., Shi, Y., Duan, S., & Li, Z. (2015) · Europe PMC (PubMed Central) · Cited by 9
Greco, M. D., Zorzi, A., Matteo, I. D., Cima, A., Maines, M., Angheben, C., & Catanzariti, D. (2016) · Heart Rhythm · doi:10.1016/j.hrthm.2016.10.025 · Cited by 9
“Although basal and mid segments of antero-lateral and infero-lateral CS branches are traditionally considered good sites for LV lead placement [2], some studies have suggested that targeting regions of delayed LV activation, rather than anatomically pre-specified LV segments, may improve the cardiac output and reduce…”
BackgroundPires, L. A., Ghio, S., Chung, E. S., Tavazzi, L., Abraham, W. T., & Gerritse, B. (2011) · Congestive Heart Failure · doi:10.1111/j.1751-7133.2010.00207.x · Cited by 9
Cardiac resynchronization therapy in NYHA class IV heart failure
Khoo, M. S. C., Kelly, P. A., & Lindenfeld, J. M. (2009) · Current Cardiology Reports · doi:10.1007/s11886-009-0026-8 · Cited by 9
“This was further supported by a larger series of 257 patients— those who received directed LV lead placement at the site of the latest mechanical activation as determined echocardiographically by speckle tracking radial strain analysis—who demonstrated superior echocardiographic response at 6-month follow-up and impro…”
ResultThe role of non-invasive imaging in patient selection
de Veire, N. R. V., Delgado, V., Schuijf, J. D., van der Wall, E. E., Schalij, M. J., & Bax, J. J. (2009) · EP Europace · doi:10.1093/europace/eup278 · Cited by 9
Self-citationSystolic heart failure and cardiac resynchronization therapy: a focus on diastole
Facchini, E., Varalda, M., Sartori, C., Burkhoff, D., & Marino, P. N. (2014) · International journal of cardiac imaging · doi:10.1007/s10554-014-0412-1 · Cited by 9
Left Ventricular Pacing Threshold and Outcome in MADIT‐CRT
Pires, L. A., McNitt, S. A., Solomon, S. D., Goldenberg, I., Zaręba, W., & Moss, A. J. (2014) · Journal of Cardiovascular Electrophysiology · doi:10.1111/jce.12448 · Cited by 9
X-ray and magnetic resonance imaging fusion for cardiac resynchronization therapy
Choi, J.-W., Radau, P. E., Xu, R., & Wright, G. A. (2016) · Medical Image Analysis · doi:10.1016/j.media.2016.03.004 · Cited by 9
Wieslander, B., Loring, Z., Zaręba, W., McNitt, S. A., Wagner, G. S., Daubert, J. P., & Strauss, D. G. (2016) · Journal of Electrocardiology · doi:10.1016/j.jelectrocard.2016.04.008 · Cited by 9
“Several factors that may predict favorable CRT response determined by echocardiography parameters and/or event-free survival have been identified, including QRS duration ≥150 ms [2], non-ischemic heart failure etiology [3], female sex [2], left ventricular (LV) lead placement (non-apical [4], at site of latest activat…”
BackgroundThe Riddle of Determining Cardiac Resynchronization Therapy Response
Marwick, T. H., & Starling, R. C. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.07.036 · Cited by 9
Chen, L., Tiongson, J. E., Obrzut, S. L., McDaniel, M. B., Chang, H., Patel, J. D., Friedman, P. J., Feld, G. K., & Birgersdotter-Green, U. M. (2012) · Journal of Interventional Cardiac Electrophysiology · doi:10.1007/s10840-012-9700-7 · Cited by 8
“Some studies have supported a more individualized approach to determining optimal lead location, where LV lead locations closest to areas of latest activation are associated with improved response [10, 12, 14].”
BackgroundCavallino, C., Rondano, E., Magnani, A., Leva, L., Inglese, E., Dell’Era, G., Occhetta, E., Bortnik, M., & Marino, P. N. (2011) · International journal of cardiac imaging · doi:10.1007/s10554-011-9908-0 · Cited by 8
Larger Interventricular Conduction Time Enhances Mechanical Response to Resynchronization Therapy
Padeletti, L., Pieragnoli, P., Ricciardi, G., Perrotta, L., Perini, A. P., Grifoni, G., Ricceri, I., Padeletti, M., Lionetti, V., & Valsecchi, S. (2013) · Pacing and Clinical Electrophysiology · doi:10.1111/pace.12068 · Cited by 8
A Meta-Analysis Of Quadripolar Versus Bipolar Left Ventricular Leads On Post-Procedural Outcomes.
Turagam, M. K., Afzal, M. R., Iskander, S., Reddy, M., Biase, L. D., Natale, A., & Lakkireddy, D. (2016) · Europe PMC (PubMed Central) · doi:10.4022/jafib.1472 · Cited by 8
Técnicas de imagen tridimensional en el tratamiento de resincronización cardiaca
Auger, D., Schalij, M. J., Bax, J. J., & Delgado, V. (2011) · Revista Española de Cardiología · doi:10.1016/j.recesp.2011.06.015 · Cited by 8
Self-citationGorcsan, J., & Tanaka, H. (2011) · Revista Española de Cardiología (English Edition) · doi:10.1016/j.rec.2011.08.005 · Cited by 8
Gorcsan, J., & Tanaka, H. (2011) · Revista Española de Cardiología · doi:10.1016/j.recesp.2011.08.004 · Cited by 8
Left ventricular wall motion analysis to guide management of CRT non-responders
Nitsche, B., Eitel, C., Bode, K., Wetzel, U., Richter, S., Döring, M., Hindricks, G., Piorkowski, C., & Gaspar, T. (2015) · EP Europace · doi:10.1093/europace/euv034 · Cited by 8
Παπαγεωργίου, Ν., Providencia, R. A., Lambiase, P. D., Tousoulis, D., Lloyd, G., & Bhattacharyya, S. (2017) · International Journal of Cardiology · doi:10.1016/j.ijcard.2017.09.034 · Cited by 8
Keilegavlen, H., Schuster, P. M., Hovstad, T., & Færestrand, S. (2020) · Journal of Arrhythmia · doi:10.1002/joa3.12450 · Cited by 8
Metadata
- 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.
- 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)
- 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
- 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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