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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

Borgquist, Rasmus LU orcid ; Mortsell, David LU orcid ; Chaudhry, Uzma LU ; Brandt, Johan LU ; Farouq, Maiwand LU and Wang, Lingwei LU orcid (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)
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author
; ; ; ; and
organization
publishing date
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&lt;0.001), left ventricular ejection fraction (+5 [IQR 2-11] absolute %, p=0.01), QRS duration (-36 [-44 to -8], p&lt;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}},
}