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Effect of left ventricular lead concordance to the delayed contraction segment on echocardiographic and clinical outcomes after cardiac resynchronization therapy.

Abstract：

INTRODUCTION:The optimal left ventricular (LV) pacing site for cardiac resynchronization therapy (CRT) is unclear. The current study aims to explore the clinical significance of LV lead concordance to delayed contraction segment in CRT. METHODS AND RESULTS:Concordant LV lead position was defined as the lead tip located by fluoroscopy at or immediately adjacent to the LV segment with latest contraction determined by tissue Doppler imaging. Echocardiographic and clinical outcomes among 101 consecutive patients with or without concordant LV lead positions were compared. There was no significant difference in changes in LV volumes and clinical parameters between patients with concordant (n = 46) or nonconcordant (n = 55) LV lead positions at 3 and 6 months. In multivariate analysis, the baseline asynchrony index (beta= 1.092, 95% CI: 1.050-1.114; P < 0.001), but not LV lead concordance, was the only independent predictor of LV reverse remodeling. By Cox regression analysis, ischemic etiology, and LV reverse remodeling, but not LV lead concordance, were independent predictors of mortality (beta= 2.475, 95% CI: 1.183-5.178; P = 0.016, and beta= 0.272, 95% CI: 0.130-0.567; P < 0.001, respectively), cardiovascular hospitalization (beta= 1.551, 95% CI: 1.032-2.333; P = 0.035, and beta= 0.460, 95% CI: 0.298-0.708; P < 0.001, respectively), and heart failure hospitalization (beta= 0.486, 95% CI: 0.320-0.738; P = 0.001 for LV reverse remodeling). CONCLUSION:LV lead concordance to the delayed contraction segment may not be a major determining factor for favorable echocardiographic and clinical outcomes after CRT.

journal_name

J Cardiovasc Electrophysiol

journal_title

Journal of cardiovascular electrophysiology

authors

Fung JW,Lam YY,Zhang Q,Yip GW,Chan WW,Chan GC,Chan JY,Yu CM

doi

10.1111/j.1540-8167.2008.01364.x

subject

Has Abstract

pub_date

2009-05-01 00:00:00

pages

530-5

issue

eissn

1045-3873

issn

1540-8167

pii

JCE1364

journal_volume

pub_type

临床试验,杂志文章

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Effect of left ventricular lead concordance to the delayed contraction segment on echocardiographic and clinical outcomes after cardiac resynchronization therapy.