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Association between left ventricular lead position and intrinsic QRS morphology with regard to clinical outcome in cardiac resynchronization therapy for heart failure

Brandtvig, Tove Olsson ; Marinko, Sofia LU ; Farouq, Maiwand LU ; Brandt, Johan LU ; Mortsell, David LU orcid ; Wang, Lingwei LU orcid ; Chaudhry, Uzma LU ; Saba, Samir and Borgquist, Rasmus LU orcid (2023) In Annals of Noninvasive Electrocardiology 28(4).
Abstract
Background
Left ventricular (LV) lead position may be an important factor for delivering effective cardiac resynchronization therapy (CRT). We therefore aimed to evaluate the effects of LV lead position, stratified by native QRS morphology, regarding the clinical outcome.

Methods
A total of 1295 CRT-implanted patients were retrospectively evaluated. LV lead position was classified as lateral, anterior, inferior, or apical, and was determined using the left and right anterior oblique X-ray views. Kaplan Meier and Cox regression were performed to evaluate the effects on all-cause mortality and heart failure hospitalization, and the potential interaction between LV lead position and native ECG... (More)
Background
Left ventricular (LV) lead position may be an important factor for delivering effective cardiac resynchronization therapy (CRT). We therefore aimed to evaluate the effects of LV lead position, stratified by native QRS morphology, regarding the clinical outcome.

Methods
A total of 1295 CRT-implanted patients were retrospectively evaluated. LV lead position was classified as lateral, anterior, inferior, or apical, and was determined using the left and right anterior oblique X-ray views. Kaplan Meier and Cox regression were performed to evaluate the effects on all-cause mortality and heart failure hospitalization, and the potential interaction between LV lead position and native ECG morphologies.

Results
A total of 1295 patients were included. Patients were aged 69 ± 7 years, 20% were female, 46% received a CRT-Pacemaker (vs. CRT-Defibrillator), mean LVEF was 25% ± 7%, and median follow-up was 3.3 years [IQR 1.6–5–7 years]. Eight hundred and eighty-two patients (68%) had a lateral LV lead location, 207 (16%) anterior, 155 (12%) apical, and 51 (4%) inferior. Patients with lateral LV lead position had larger QRS reduction (−13 ± 27 ms vs. −3 ± 24 ms, p 
Conclusions
In patients treated with CRT, non-lateral LV lead positions (including apical, anterior, and inferior positions) were associated with worse clinical outcome and less reduction of QRS duration. This association was strongest for patients with native LBBB or RBBB. (Less)
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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Annals of Noninvasive Electrocardiology
volume
28
issue
4
publisher
Wiley-Blackwell
external identifiers
  • scopus:85159635414
  • pmid:37200452
ISSN
1082-720X
DOI
10.1111/anec.13065
language
English
LU publication?
yes
id
c93b743b-0a30-4e89-ba56-948ed89a20cf
date added to LUP
2023-05-18 22:38:59
date last changed
2023-10-26 15:03:20
@article{c93b743b-0a30-4e89-ba56-948ed89a20cf,
  abstract     = {{Background<br/>Left ventricular (LV) lead position may be an important factor for delivering effective cardiac resynchronization therapy (CRT). We therefore aimed to evaluate the effects of LV lead position, stratified by native QRS morphology, regarding the clinical outcome.<br/><br/>Methods<br/>A total of 1295 CRT-implanted patients were retrospectively evaluated. LV lead position was classified as lateral, anterior, inferior, or apical, and was determined using the left and right anterior oblique X-ray views. Kaplan Meier and Cox regression were performed to evaluate the effects on all-cause mortality and heart failure hospitalization, and the potential interaction between LV lead position and native ECG morphologies.<br/><br/>Results<br/>A total of 1295 patients were included. Patients were aged 69 ± 7 years, 20% were female, 46% received a CRT-Pacemaker (vs. CRT-Defibrillator), mean LVEF was 25% ± 7%, and median follow-up was 3.3 years [IQR 1.6–5–7 years]. Eight hundred and eighty-two patients (68%) had a lateral LV lead location, 207 (16%) anterior, 155 (12%) apical, and 51 (4%) inferior. Patients with lateral LV lead position had larger QRS reduction (−13 ± 27 ms vs. −3 ± 24 ms, p <br/>Conclusions<br/>In patients treated with CRT, non-lateral LV lead positions (including apical, anterior, and inferior positions) were associated with worse clinical outcome and less reduction of QRS duration. This association was strongest for patients with native LBBB or RBBB.}},
  author       = {{Brandtvig, Tove Olsson and Marinko, Sofia and Farouq, Maiwand and Brandt, Johan and Mortsell, David and Wang, Lingwei and Chaudhry, Uzma and Saba, Samir and Borgquist, Rasmus}},
  issn         = {{1082-720X}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{4}},
  publisher    = {{Wiley-Blackwell}},
  series       = {{Annals of Noninvasive Electrocardiology}},
  title        = {{Association between left ventricular lead position and intrinsic QRS morphology with regard to clinical outcome in cardiac resynchronization therapy for heart failure}},
  url          = {{http://dx.doi.org/10.1111/anec.13065}},
  doi          = {{10.1111/anec.13065}},
  volume       = {{28}},
  year         = {{2023}},
}