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...

Full description

Saved in:
Bibliographic Details
Published in:European Journal of Heart Failure Vol. 8; no. 6; pp. 609 - 615
Main Authors:
Format: Article
Published: John Wiley & Sons, Inc., Oct2006
Subjects:
Online Access:Go to the source
Tags: Add Tag
Be the first to tag this record!
fields Array ( [recordID] => 1 )
Array ( )
http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=22797661&site=ehost-live
Array ( [@attributes] => Array ( [shortDbName] => a9h [uiTerm] => 22797661 [longDbName] => Academic Search Complete [uiTag] => AN ) [controlInfo] => Array ( [bkinfo] => Array ( ) [jinfo] => Array ( [jid] => Array ( [0] => 13889842 [1] => P3O ) [jtl] => European Journal of Heart Failure [issn] => 13889842 [maglogo] => N ) [pubinfo] => Array ( [dt] => Oct2006 [vid] => 8 [iid] => 6 [pub] => John Wiley & Sons, Inc. ) [artinfo] => Array ( [ui] => Array ( [0] => 22797661 [1] => 10.1016/j.ejheart.2005.11.009 ) [ppf] => 609 [ppct] => 6 [formats] => Array ( [fmt] => Array ( [@attributes] => Array ( [type] => P [size] => 328KB ) ) ) [tig] => Array ( [atl] => Optimization of right ventricular lead position in cardiac resynchronisation therapy ) [aug] => Array ( [au] => Array ( [0] => Riedlbauchová, Lucie [1] => Čihák, Robert [2] => Bytešník, Jan [3] => Vančura, Vlastimil [4] => Frídl, Petr [5] => Hošková, Lenka [6] => Kautzner, Josef ) [affil] => Department of Cardiology, Institute for Clinical and Experimental Medicine, Vídeòská 1958/9, 140 21 Praha 4, Prague, Czech Republic ) [su] => Array ( [0] => HEART failure [1] => HEART diseases [2] => CARDIOMYOPATHIES [3] => CARDIAC pacing [4] => ARRHYTHMIA treatment ) [sug] => Array ( [subj] => Array ( [0] => HEART failure [1] => HEART diseases [2] => CARDIOMYOPATHIES [3] => CARDIAC pacing [4] => ARRHYTHMIA treatment ) ) [keyword] => Array ( [0] => biventricular pacing ( BiV ) [1] => Cardiac pacing [2] => Cardiac resynchronisation therapy [3] => Chronic heart failure [4] => coronary artery disease ( CAD ) [5] => idiopathic dilated cardiomyopathy ( DCM ) [6] => interventricular conduction time ( RV-LV interval ) [7] => Lead position [8] => left bundle branch block ( LBBB ) [9] => Left ventricle [10] => left ventricle/left-ventricular ( LV ) [11] => left-ventricular ejection fraction ( LVEF ) [12] => left-ventricular end-diastolic diameter ( LVEDD ) [13] => maximum oxygen uptake ( VO2max ) [14] => midseptal position of the RV lead ( RVS ) [15] => QRS duration during BiV pacing ( QRS-BiV ) [16] => QRS duration during single-site LV and RV pacing ( QRS-LV and QRS-RV ) [17] => Remodelling [18] => right ventricle/right-ventricular ( RV ) [19] => right ventricular apical position ( RVA ) ) [ab] => 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. [pubtype] => Academic Journal [doctype] => Article [src] => R ) [language] => English [refInfo] => Array ( ) [copyright] => Array ( [@attributes] => Array ( [flag] => Y ) [custom] => Copyright of European Journal of Heart Failure is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. [item] => European Journal of Heart Failure [holder] => John Wiley & Sons, Inc. [dt] => Array ( [@attributes] => Array ( [year] => 2006 ) ) ) [holdings] => Array ( [@attributes] => Array ( [islocal] => N ) ) ) )