Impact of Left Ventricular Lead Position on Cardiac Resynchronization Therapy

Abstract

Background: Optimal left ventricular (LV) site selection is major clinical interest for cardiac resynchronization therapy (CRT) implantation. The impact of LV lead position on outcome in CRT patients is still unclear. Methods and Results: We evaluated 109 consecutive heart failure (HF) patients (age 63±13 years, LV ejection fraction 26±11%, QRS duration 163±37 ms) who had successfully placement LV lead with follow-up of 703±352 days. The location of the LV lead was assessed by chest X-rays and coronary venograms at device implantation. The LV lead position was classified into an anterior, lateral or posterior position along the short axis and into a basal, midventricular or apical position along the long axis. After CRT implantation, improvement of HF symptoms did not depend on the LV lead positions. No significant changes were found in the magnitude of left ventricular reverse remodeling and the proportion of responders between the LV lead positions. Based on the Kaplan-Meier analysis, the apical lead location indicated higher tendency in HF/death compared with non-apical position (p=0.10), whereas the benefit of CRT was indifferent to the lead position along the short axis (p=0.876). Conclusion: LV lead position associated with the short axis was not a major determinant of response to CRT. However apical site LV lead position could be unfavorable on outcome.