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- Title
Clinical Outcomes of Cardiac Resynchronization with Epicardial Left Ventricular Lead.
- Authors
CHEN, LU; FU, HAIXIA; PRETORIUS, VICTOR G.; YANG, DACHUN; WISTE, HEATHER J.; YUAN, HONGTAO; FELD, GREGORY K.; CHA, YONG‐MEI; BIRGERSDOTTER‐GREEN, ULRIKA M.
- Abstract
Background Left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) can be achieved via a transvenous or epicardial route. A surgically implanted epicardial LV (eLV) lead is used after a standard transvenous LV (tLV) lead implantation has failed. However, studies of clinical outcomes in patients with eLV leads and comparisons of outcome between tLV and eLV-CRT are sparse. Therefore, the purpose of this study is to compare clinical response between tLV-CRT and eLV-CRT, as well as to understand the differences within the eLV-CRT population. Methods Forty-four patients received eLV-CRT following unsuccessful attempts of tLV-CRT implantation between 2002 and 2013 at the University of California, San Diego (UCSD) and Mayo Clinics. These patients were matched for age, gender, and etiology of cardiomyopathy in a 1:2 ratio with a cohort of patients who received tLV-CRT during the same time period. Results During a mean follow-up of 57 months, similar clinical outcomes and survival rate were noted between tLV and eLV-CRT patients (all P > 0.05). Within the eLV-CRT group, dilated cardiomyopathy patients had significant improvement in New York Heart Association class and ejection fraction (both P < 0.05), while ischemic cardiomyopathy patients did not (both P > 0.05). eLV-CRT patients with nonanterior lead location had significantly improved survival (P < 0.001). There was also a trend for improved survival in those with nonapical lead location (P = 0.09). Conclusion In this case-matched two-centered study, comparable improvements were noted in patients with tLV-CRT and eLV-CRT. Operators should target nonanterior and nonapical locations during eLV-CRT implantation. Use of eLV-CRT should be considered a viable alternative for CRT candidates.
- Subjects
CALIFORNIA; MINNESOTA; TREATMENT of cardiomyopathies; CARDIAC output; CARDIAC pacing; CHEST X rays; THORACIC surgery; CHI-squared test; ELECTRODES; LEFT heart ventricle; HEART beat; LENGTH of stay in hospitals; ARTIFICIAL implants; PERICARDIUM; SURGICAL complications; SURVIVAL analysis (Biometry); T-test (Statistics); TREATMENT effectiveness; PRE-tests &; post-tests; RETROSPECTIVE studies; DATA analysis software; DESCRIPTIVE statistics
- Publication
Pacing & Clinical Electrophysiology, 2015, Vol 38, Issue 10, p1201
- ISSN
0147-8389
- Publication type
Article
- DOI
10.1111/pace.12687