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- Title
Multimodality imaging-guided left ventricular lead placement in cardiac resynchronization therapy: a randomized controlled trial.
- Authors
Sommer, Anders; Kronborg, Mads Brix; Nørgaard, Bjarne Linde; Poulsen, Steen Hvitfeldt; Bouchelouche, Kirsten; Böttcher, Morten; Jensen, Henrik Kjærulf; Jensen, Jesper Møller; Kristensen, Jens; Gerdes, Christian; Mortensen, Peter Thomas; Nielsen, Jens Cosedis
- Abstract
Aim Left ventricular (LV) lead position at the latest mechanically activated non-scarred myocardial LV region confers improved response to cardiac resynchronization therapy (CRT).We conducted a double-blind, randomized controlled trial to evaluate the clinical benefit of multimodality imaging-guided LV lead placement in CRT. Methods and results Patients were allocated (1:1) to imaging-guided LV lead placement using cardiac computed tomography (CT) venography, 99mTechnetium myocardial perfusion imaging, and speckle-tracking echocardiography radial strain to target the optimal coronary sinus (CS) branch closest to the non-scarred myocardial segment with latest mechanical activation (imaging group, n=89) or to routine LV lead implantation in a posterolateral region with late electrical activation (control group, n=93). The primary endpoint was clinical non-response to CRT [≥1 of the following after 6months: (1) death, (2) heart failure hospitalization, or (3) no improvement in New York Heart Association class and <10% increase in 6-min walk distance]. Secondary outcomes included LV remodelling and the combination of all-cause mortality and hospitalization owing to heart failure during 1.8±0.9 years. Analysis was intention-to-treat. In the imaging group, fewer patients reached the primary endpoint (26% vs. 42%, P =0.02). More patients in the imaging group had the LV lead placed in the optimal CS branch (83% vs. 65%, P =0.01). There were no between-group differences in reverse LV remodelling or the combined endpoint of death or hospitalizations for heart failure. Conclusions Multimodality imaging-guided LV lead placement towards the CS branch closest to latest mechanically activated non-scarred myocardial LV segment reduces the proportion of clinical non-responders to CRT. Larger long-term multicentre studies are needed.
- Subjects
CARDIAC pacing; COMPUTED tomography; ECHOCARDIOGRAPHY; HEART failure; PERFUSION; RADIONUCLIDE imaging
- Publication
European Journal of Heart Failure. Supplements, 2016, Vol 18, Issue 11, p1365
- ISSN
1567-4215
- Publication type
Article
- DOI
10.1002/ejhf.530