Optimization of right ventricular lead position in cardiac resynchronisation therapy

Abstract: Background: The benefit of biventricular pacing (BiV) may be substantially affected by optimal lead placement. Aim: To evaluate the importance of right ventricular (RV) lead positioning on clinical outcome of BiV. Methods and results: A total of 99 patients with symptomatic heart failure a...

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Bibliographic Details
Published in:European Journal of Heart Failure Vol. 8; no. 6; pp. 609 - 615
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Format: Article
Published: John Wiley & Sons, Inc., Oct2006
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Summary:Abstract: Background: The benefit of biventricular pacing (BiV) may be substantially affected by optimal lead placement. Aim: To evaluate the importance of right ventricular (RV) lead positioning on clinical outcome of BiV. Methods and results: A total of 99 patients with symptomatic heart failure and implantation of BiV system were included. Position of the left-ventricular (LV) lead was selected based on timing of local endocardial signal within the terminal portion of the QRS complex. RV lead was preferably positioned at the midseptum (n =74, RVS group) where the earliest RV endocardial signal was recorded. A subgroup of patients had RV lead placed in the apex (n =25, RVA group). NYHA class, maximum oxygen-uptake (VO2max), LV end-diastolic diameter (LVEDD, mm) and ejection fraction were assessed every third month. A trend towards greater improvement in NYHA class and significant increase in VO2max was present in the RVS group. Moreover, a significant decrease in LVEDD (ΔLVEDD) was observed in the RVS group only (−3.4±6.5 mm versus +1.7±6.4 mm in RVA group at 12 months, p =0.004). No significant correlation between the degree of ΔLVEDD and QRS narrowing induced by BiV was found. LVEDD reduction was predominantly present in dilated cardiomyopathy. Conclusions: Midseptal positioning of the RV lead appears to promote reverse LV remodelling during cardiac resynchronisation therapy.