© 2005 European Society of Cardiology
Optimization of right ventricular lead position in cardiac resynchronisation therapy
ihaák
ník
urakovaáDepartment of Cardiology, Institute for Clinical and Experimental Medicine Vídeòská 1958/9, 140 21 Praha 4, Prague, Czech Republic
* Corresponding author. Tel.: +42 26108 2353; fax: +42 24172 8225. E-mail address:josef.kautzner{at}medicon.cz (J. Kautzner)
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Abstract |
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Background: The benefit of biventricular pacing (BiV) may be substantially affected by optimal lead placement.
Aim: To evaluate the importance of right ventricular (RV) lead positioning on clinical outcome of BiV.
Methods and results: A total of 99 patients with symptomatic heart failure and implantation of BiV system were included. Position of the left-ventricular (LV) lead was selected based on timing of local endocardial signal within the terminal portion of the QRS complex. RV lead was preferably positioned at the midseptum (n = 74, RVS group) where the earliest RV endocardial signal was recorded. A subgroup of patients had RV lead placed in the apex (n = 25, RVA group). NYHA class, maximum oxygen-uptake (VO2max), LV end-diastolic diameter (LVEDD, mm) and ejection fraction were assessed every third month.
A trend towards greater improvement in NYHA class and significant increase in VO2max was present in the RVS group. Moreover, a significant decrease in LVEDD (
LVEDD) was observed in the RVS group only (– 3.4 ± 6.5 mm versus + 1.7 ± 6.4 mm in RVA group at 12 months, p = 0.004). No significant correlation between the degree of LVEDD and QRS narrowing induced by BiV was found. LVEDD reduction was predominantly present in dilated cardiomyopathy.
Conclusions: Midseptal positioning of the RV lead appears to promote reverse LV remodelling during cardiac resynchronisation therapy.
Key Words: Cardiac pacing • Lead position • Left ventricle • Cardiac resynchronisation therapy • Chronic heart failure • Remodelling
Received January 28, 2005; Revised September 2, 2005; Accepted November 17, 2005
This study was supported by the Research Grant 8541-3/2005 of the Internal Grant Agency of the Ministry of Health of the Czech Republic.
1 Riedlbauchová, RV lead positioning during CRT.
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