Repositioning and optimization of left ventricular lead position in non-responders to Cardiac Resynchronization Therapy is associated with improved ejection fraction, lower NT-ProBNP values and less heart failure symptoms
(2022) In Heart Rhythm O2 3(5). p.457-463- Abstract
- Background
Observational data suggests that an anterior or apical left ventricular (LV) position in Cardiac Resynchronization Therapy (CRT) is associated with worse outcome and higher likelihood of “non-response”. It is not known whether the benefits of optimizing LV lead position in a second procedure outweighs the procedural risks.
Objective
To evaluate the clinical effects of LV lead repositioning.
Methods
During the period 2015-2020, we identified all patients where the indication for the procedure was LV lead repositioning due to “non-response” in combination with suboptimal LV lead position. All patients were followed with a structured visit 6-months post LV lead revision. Heart failure hospitalization and... (More) - Background
Observational data suggests that an anterior or apical left ventricular (LV) position in Cardiac Resynchronization Therapy (CRT) is associated with worse outcome and higher likelihood of “non-response”. It is not known whether the benefits of optimizing LV lead position in a second procedure outweighs the procedural risks.
Objective
To evaluate the clinical effects of LV lead repositioning.
Methods
During the period 2015-2020, we identified all patients where the indication for the procedure was LV lead repositioning due to “non-response” in combination with suboptimal LV lead position. All patients were followed with a structured visit 6-months post LV lead revision. Heart failure hospitalization and mortality data was gathered from the medical records and cross-checked with the population registry.
Results
A total of 25 patients were identified who fulfilled the inclusion criteria. All procedures were successful in establishing LV lead pacing in a lateral mid- or basal location. Median follow-up was 2.5 years [1.1-3.7]. There were improvements in NYHA class (mean -0.5±0.5 class, p<0.001), left ventricular ejection fraction (+5 [IQR 2-11] absolute %, p=0.01), QRS duration (-36 [-44 to -8], p<0.001) and NT-ProBNP (-615 [-2837 to +121] ng/L, p=0.03). Clinical outcome was similar to a reference population with CRT (p=ns).
Conclusion
In non-responders to CRT with either an anterior or inferior LV lead position, it was feasible to perform LV lead repositioning in all cases, with a low complication rate. Changing the LV lead position was associated with improved LV ejection fraction, larger QRS-reduction and larger NT-ProBNP reduction. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/2854009f-ffe2-4796-aeb5-4d6f6eb2f6f5
- author
- Borgquist, Rasmus LU ; Mortsell, David LU ; Chaudhry, Uzma LU ; Brandt, Johan LU ; Farouq, Maiwand LU and Wang, Lingwei LU
- organization
- publishing date
- 2022-06-27
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Heart Rhythm O2
- volume
- 3
- issue
- 5
- pages
- 457 - 463
- publisher
- Elsevier
- external identifiers
-
- scopus:85135967668
- pmid:36340500
- DOI
- 10.1016/j.hroo.2022.06.010
- language
- English
- LU publication?
- yes
- id
- 2854009f-ffe2-4796-aeb5-4d6f6eb2f6f5
- date added to LUP
- 2022-07-08 17:40:11
- date last changed
- 2023-01-16 10:16:51
@article{2854009f-ffe2-4796-aeb5-4d6f6eb2f6f5, abstract = {{Background<br/>Observational data suggests that an anterior or apical left ventricular (LV) position in Cardiac Resynchronization Therapy (CRT) is associated with worse outcome and higher likelihood of “non-response”. It is not known whether the benefits of optimizing LV lead position in a second procedure outweighs the procedural risks.<br/>Objective<br/>To evaluate the clinical effects of LV lead repositioning.<br/>Methods<br/>During the period 2015-2020, we identified all patients where the indication for the procedure was LV lead repositioning due to “non-response” in combination with suboptimal LV lead position. All patients were followed with a structured visit 6-months post LV lead revision. Heart failure hospitalization and mortality data was gathered from the medical records and cross-checked with the population registry.<br/>Results<br/>A total of 25 patients were identified who fulfilled the inclusion criteria. All procedures were successful in establishing LV lead pacing in a lateral mid- or basal location. Median follow-up was 2.5 years [1.1-3.7]. There were improvements in NYHA class (mean -0.5±0.5 class, p<0.001), left ventricular ejection fraction (+5 [IQR 2-11] absolute %, p=0.01), QRS duration (-36 [-44 to -8], p<0.001) and NT-ProBNP (-615 [-2837 to +121] ng/L, p=0.03). Clinical outcome was similar to a reference population with CRT (p=ns).<br/>Conclusion<br/>In non-responders to CRT with either an anterior or inferior LV lead position, it was feasible to perform LV lead repositioning in all cases, with a low complication rate. Changing the LV lead position was associated with improved LV ejection fraction, larger QRS-reduction and larger NT-ProBNP reduction.}}, author = {{Borgquist, Rasmus and Mortsell, David and Chaudhry, Uzma and Brandt, Johan and Farouq, Maiwand and Wang, Lingwei}}, language = {{eng}}, month = {{06}}, number = {{5}}, pages = {{457--463}}, publisher = {{Elsevier}}, series = {{Heart Rhythm O2}}, title = {{Repositioning and optimization of left ventricular lead position in non-responders to Cardiac Resynchronization Therapy is associated with improved ejection fraction, lower NT-ProBNP values and less heart failure symptoms}}, url = {{http://dx.doi.org/10.1016/j.hroo.2022.06.010}}, doi = {{10.1016/j.hroo.2022.06.010}}, volume = {{3}}, year = {{2022}}, }