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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”
From The Year of 2008 in Electrocardiology (2010) · cites this paper as [18]
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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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