Surface Electrogram-guided Left Ventricular Lead Placement Improves Response to Cardiac Resynchronization Therapy

Overview

Journal Anatol J Cardiol

Publisher Kare Publishing

Specialty Cardiology & Vascular Diseases

Date 2018 Mar 10

PMID 29521312

Citations 7

Authors

Abdulcebbar Sipal

Serdar Bozyel

Mujdat Aktas

Emir Dervis

Tayyar Akbulut

Onur Argan

Umut Celikyurt

Dilek Ural

Tayfun Sahin

Aysen Agir

Ahmet Vural

Affiliations

Soon will be listed here.

Abstract

Objective: Failure to select the optimal left ventricular (LV) segment for lead implantation is one of the most important causes of unresponsiveness to the cardiac resynchronization therapy (CRT). In our study, we aimed to investigate the echocardiographic and clinical benefits of LV lead implantation guided by an intraoperative 12-lead surface electrocardiogram (ECG) in patients with multiple target veins.

Methods: We included 80 [42 (62.5%) male] heart failure patients who successfully underwent CRT defibrillator (CRT-D) implantation. Patients were divided into two groups. In group 1, LV lead was positioned at the site with the shortest biventricular-paced (BiV-paced) QRS duration (QRSd), as intraprocedurally measured using surface ECG. In group 2 (control), we included patients who underwent the standard unguided CRT. ECG, echocardiogram, and functional status were evaluated before and 6 months after CRT implantation in all patients.

Results: In group 1, BiV-paced QRSd measurements were successfully performed in 112 of 120 coronary sinus branches during CRT and an LV lead was successfully placed at the optimal site in all patients. Compared with group 2, group 1 had a significantly higher rate (85% vs. 50%, p=0.02) of response (>15% reduction in LV end-systolic volume) to CRT as well as a shorter QRSd (p<0.001) and a greater QRS shortening (ΔQRS) associated with CRT compared with baseline (p<0.001). The mean New York Heart Association functional class was significantly improved in both groups, and no significant differences were found in clinical response to CRT (85% vs. 70%, p=0.181).

Conclusion: Surface ECG can be used to guide LV lead placement in patients with multiple target veins for improving response to CRT. Thus, it is a safe, feasible, and economic approach for CRT-D implantation.

Citing Articles

Targeted left ventricular lead positioning to the site of latest activation in cardiac resynchronization therapy: a systematic review and meta-analysis.

Fyenbo D, Bjerre H, Frausing M, Stephansen C, Sommer A, Borgquist R Europace. 2023; 25(9).

PMID: 37695316 PMC: 10507669. DOI: 10.1093/europace/euad267.

The role of guidance in delivering cardiac resynchronization therapy: A systematic review and network meta-analysis.

Mehta V, Ayis S, Elliott M, Widjesuriya N, Kardaman N, Gould J Heart Rhythm O2. 2022; 3(5):482-492.

PMID: 36340494 PMC: 9626880. DOI: 10.1016/j.hroo.2022.07.005.

Determinants of LV dP/dt and QRS duration with different fusion strategies in cardiac resynchronisation therapy.

Odland H, Holm T, Gammelsrud L, Cornelussen R, Kongsgaard E Open Heart. 2021; 8(1).

PMID: 33963078 PMC: 8108692. DOI: 10.1136/openhrt-2021-001615.

The Evolving Role of Electrocardiography in Cardiac Resynchronization Therapy.

Noheria A, Sodhi S, Orme G Curr Treat Options Cardiovasc Med. 2019; 21(12):91.

PMID: 31828564 DOI: 10.1007/s11936-019-0784-6.

Optimization of Lead Placement in the Right Ventricle During Cardiac Resynchronization Therapy. A Simulation Study.

Carpio E, Gomez J, Sebastian R, Lopez-Perez A, Castellanos E, Almendral J Front Physiol. 2019; 10:74.

PMID: 30804805 PMC: 6378298. DOI: 10.3389/fphys.2019.00074.

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