PMID- 19136489
OWN - NLM
STAT- MEDLINE
DCOM- 20090528
LR  - 20220321
IS  - 1532-2092 (Electronic)
IS  - 1099-5129 (Linking)
VI  - 11
IP  - 3
DP  - 2009 Mar
TI  - Effect of right ventricular lead location on response to cardiac 
      resynchronization therapy in patients with end-stage heart failure.
PG  - 356-63
LID - 10.1093/europace/eun375 [doi]
AB  - AIMS: It is currently recommended to implant the left ventricular (LV) pacing 
      lead at the lateral wall. However, the optimal right ventricular (RV) pacing lead 
      location for cardiac resynchronization therapy (CRT) remains controversial. We 
      sought to investigate whether optimizing the site for placement of the RV lead 
      could further improve the long-term response to CRT in patients with advanced 
      heart failure. METHODS AND RESULTS: Between October 2006 and December 2007, a 
      total of 73 consecutive patients with standard indication for CRT were enrolled. 
      The enrolled patients were divided into two groups based on the RV lead location. 
      There were 50 patients in RV apex (RVA) group and 23 patients in RV high septum 
      (RVHS). The primary study endpoint was a decrease in LV end-systolic volume 
      (LVESV) by >15% at 6-month follow-up. The secondary endpoints were improvement in 
      New York Heart Association (NYHA) class by >or=1 point and decrease in brain-type 
      natriuretic peptide (BNP) levels by >50% after CRT. At 6-month follow-up, 
      improvement in NYHA class by >or=1 point (RVA: 72% vs. RVHS: 74%, P = 0.76), 
      decrease in LVESV by >or=15% (RVA: 65% vs. RVHS: 64%, P = 0.76), and decrease in 
      BNP level by >50% (RVA: 70% vs. RVHS: 69%, P = 0.88) were observed in similar 
      proportion of the two groups. When we separately assessed the significance of RV 
      pacing site in three LV stimulation sites, there were no significant differences 
      in terms of clinical improvement (62 vs. 64%, P = 0.74) and decrease in LVESV by 
      >15% (63 vs. 62%, P = 0.78) between RVA and RVHS pacing when the LV stimulation 
      site was lateral cardiac vein. In anterolateral vein pacing site, the RVA 
      stimulation was associated with higher clinical (88 vs. 47%, P = 0.05), 
      echocardiographic (75 vs. 32%, P = 0.02), and neurohormonal responses (80 vs. 
      50%, P = 0.04) compared with that in RVHS site. When LV was paced from 
      posterolateral vein, RVHS pacing was superior to RVA in terms of the clinical 
      improvement (85 vs. 35%, P = 0.01), echocardiographic response (72 vs. 30%, P = 
      0.01), and decrease in BNP levels (75 vs. 50%, P = 0.04). CONCLUSION: The present 
      study did not show any difference between RVA and RVHS pacing sites in terms of 
      overall improvement in clinical outcome and LV reverse remodelling following CRT. 
      However, effect of RV lead location on CRT response varies depending on LV 
      stimulation site.
FAU - Haghjoo, Majid
AU  - Haghjoo M
AD  - Department of Pacemaker and Electrophysiology, Rajaie Cardiovascular Medical and 
      Research Center, Iran University of Medical Sciences, PO Box: 15745-1341, Mellat 
      Park, Vali-E-Asr Avenue, Tehran 1996911151, Iran. majid.haghjoo@gmail.com
FAU - Bonakdar, Hamid Reza
AU  - Bonakdar HR
FAU - Jorat, Mohammad Vahid
AU  - Jorat MV
FAU - Fazelifar, Amir Farjam
AU  - Fazelifar AF
FAU - Alizadeh, Abolfath
AU  - Alizadeh A
FAU - Ojaghi-Haghjghi, Zahra
AU  - Ojaghi-Haghjghi Z
FAU - Esmaielzadeh, Maryam
AU  - Esmaielzadeh M
FAU - Sadr-Ameli, Mohammad Ali
AU  - Sadr-Ameli MA
LA  - eng
PT  - Controlled Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20090109
PL  - England
TA  - Europace
JT  - Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal 
      of the working groups on cardiac pacing, arrhythmias, and cardiac cellular 
      electrophysiology of the European Society of Cardiology
JID - 100883649
SB  - IM
MH  - Cardiac Pacing, Artificial/*methods
MH  - *Electrodes, Implanted
MH  - Female
MH  - Heart Failure/*prevention & control
MH  - Heart Ventricles/*surgery
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - *Pacemaker, Artificial
MH  - Prosthesis Implantation/*methods
MH  - Terminal Care
EDAT- 2009/01/13 09:00
MHDA- 2009/05/29 09:00
CRDT- 2009/01/13 09:00
PHST- 2009/01/13 09:00 [entrez]
PHST- 2009/01/13 09:00 [pubmed]
PHST- 2009/05/29 09:00 [medline]
AID - eun375 [pii]
AID - 10.1093/europace/eun375 [doi]
PST - ppublish
SO  - Europace. 2009 Mar;11(3):356-63. doi: 10.1093/europace/eun375. Epub 2009 Jan 9.