PMID- 20298819
OWN - NLM
STAT- MEDLINE
DCOM- 20110613
LR  - 20161222
IS  - 1556-3871 (Electronic)
IS  - 1547-5271 (Linking)
VI  - 7
IP  - 5
DP  - 2010 May
TI  - Impact of segmental left ventricle lead position on cardiac resynchronization 
      therapy outcomes.
PG  - 639-44
LID - 10.1016/j.hrthm.2010.01.035 [doi]
AB  - BACKGROUND: The optimal pacing site for cardiac resynchronization therapy (CRT) 
      is along the left ventricle (LV) lateral or posterolateral wall. However, little 
      is known about the impact of segmental pacing site on outcomes. OBJECTIVE: We 
      assessed the impact of segmental LV lead position on CRT outcomes. METHODS: 
      Patients (n = 115) undergoing CRT were followed prospectively. Segmental LV lead 
      position along the longitudinal axis (apical, midventricle, or basal) was 
      determined retrospectively by examining coronary sinus (CS) venograms and chest 
      X-rays. The primary outcome was a combined endpoint of heart failure 
      hospitalization, cardiac transplantation, or all-cause mortality. Secondary 
      outcomes included change in New York Heart Association (NYHA) functional class 
      and degree of LV reverse remodeling. RESULTS: 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 +/- 8.9 vs. 66.5 +/- 13.3 years; P = .010) 
      and more likely to have ischemic cardiomyopathy (77% vs. 52%, P <.001). During a 
      mean follow-up of 15.1 +/- 9.0 months, event-free survival was significantly 
      lower in the apical group: 52% vs. 79%, hazard ratio [HR] 2.7 (95% confidence 
      interval [CI] 1.5-5.5, P = .006). The adverse impact of apical lead placement 
      remained significant after adjusting for clinical covariates: HR 2.3 (95% CI 
      1.1-4.8, P = .03). The apical group also experienced less improvement in NYHA 
      functional class and less LV reverse remodeling. CONCLUSIONS: Apical LV lead 
      placement is associated with worse CRT outcomes. Preferential positioning of LV 
      leads in the basal/midventricle segments may improve outcomes.
CI  - Copyright 2010. Published by Elsevier Inc.
FAU - Merchant, Faisal M
AU  - Merchant FM
AD  - Cardiology Division, Massachusetts General Hospital and Harvard Medical School, 
      Boston, Massachusetts 02114, USA.
FAU - Heist, E Kevin
AU  - Heist EK
FAU - McCarty, David
AU  - McCarty D
FAU - Kumar, Prabhat
AU  - Kumar P
FAU - Das, Saumya
AU  - Das S
FAU - Blendea, Dan
AU  - Blendea D
FAU - Ellinor, Patrick T
AU  - Ellinor PT
FAU - Mela, Theofanie
AU  - Mela T
FAU - Picard, Michael H
AU  - Picard MH
FAU - Ruskin, Jeremy N
AU  - Ruskin JN
FAU - Singh, Jagmeet P
AU  - Singh JP
LA  - eng
PT  - Journal Article
DEP - 20100201
PL  - United States
TA  - Heart Rhythm
JT  - Heart rhythm
JID - 101200317
SB  - IM
CIN - Heart Rhythm. 2010 May;7(5):645-6. PMID: 20206326
MH  - Aged
MH  - Cardiac Pacing, Artificial/*adverse effects/statistics & numerical data
MH  - Cardiomyopathies
MH  - Confidence Intervals
MH  - Electrodes, Implanted/adverse effects/statistics & numerical data
MH  - Female
MH  - Health Status Indicators
MH  - Heart Failure/mortality/*therapy
MH  - Heart Transplantation
MH  - *Heart Ventricles
MH  - Hospitalization
MH  - Humans
MH  - Male
MH  - Massachusetts
MH  - Multivariate Analysis
MH  - Myocardium
MH  - Prospective Studies
MH  - Retrospective Studies
MH  - Stroke Volume
MH  - Systole
MH  - *Treatment Outcome
MH  - Ventricular Function, Left
EDAT- 2010/03/20 06:00
MHDA- 2011/06/15 06:00
CRDT- 2010/03/20 06:00
PHST- 2009/10/28 00:00 [received]
PHST- 2010/01/22 00:00 [accepted]
PHST- 2010/03/20 06:00 [entrez]
PHST- 2010/03/20 06:00 [pubmed]
PHST- 2011/06/15 06:00 [medline]
AID - S1547-5271(10)00066-4 [pii]
AID - 10.1016/j.hrthm.2010.01.035 [doi]
PST - ppublish
SO  - Heart Rhythm. 2010 May;7(5):639-44. doi: 10.1016/j.hrthm.2010.01.035. Epub 2010 
      Feb 1.