We found a match
Your institution may have rights to this item. Sign in to continue.
- Title
Left Ventricular Lead Proximity to an Akinetic Segment and Impact on Outcome of Cardiac Resynchronization Therapy.
- Authors
ARZOLA‐CASTANER, DANIEL; TAUB, CYNTHIA; KEVIN HEIST, E.; FAN, DALI; HAELEWYN, KYLE; MELA, THEOFANIE; PICARD, MICHAEL H.; RUSKIN, JEREMY N.; SINGH, JAGMEET P.
- Abstract
Background: Previous studies report that the optimal pacing site for cardiac resynchronization therapy (CRT) is along the left ventricular (LV) lateral and postero-lateral (PL) wall. However, little is known regarding whether pacing over an akinetic site impacts the contractile response and long-term outcome from CRT. Methods and Results: A total of 38 patients with ischemic cardiomyopathy were studied for their acute hemodynamic and 12-month clinical response to CRT. The intraindividual percentage change in dP/dt (%ΔdP/dt), over baseline, was derived from the mitral regurgitation (MR) Doppler profile with CRT on versus off. Two-dimensional echocardiography was used for myocardial segmentation and determinination of akinetic sites. LV lead implant site was determined using angiographic and radiographic data and categorized as being “on” (group 1) or “off” (group 2) an akinetic site. Long-term response was measured as a combined endpoint of hospitalization for heart failure and/or all cause mortality at 12 months. Time to primary endpoint was estimated by the Kaplan-Meier method. Clinical characteristics and acute hemodynamic response was similar in both (group 1 [n = 14]; %ΔdP/dt 48.8 ± 67.4% vs group 2 [n = 24]; %ΔdP/dt 32.2 ± 40.1%, P = 0.92). No difference in long-term outcome was observed (P = 0.59). In contrast, lead placement in PL or mid-lateral (ML) positions was associated with a better acute hemodynamic response when compared to antero-lateral (AL) positions (PL, %ΔdP/dt 45.7 ± 50.7% and ML, %ΔdP/dt 45.1 ± 58.8% vs AL, %ΔdP/dt 2.9 ± 30.9%, respectively, P = 0.014). Conclusion: LV lead proximity to an akinetic segment does not impact acute hemodynamic or 12-month clinical response to CRT.
- Subjects
ECHOCARDIOGRAPHY; LEFT heart ventricle; MITRAL valve insufficiency; ARTIFICIAL implants; ANGIOGRAPHY
- Publication
Journal of Cardiovascular Electrophysiology, 2006, Vol 17, Issue 6, p623
- ISSN
1045-3873
- Publication type
Article
- DOI
10.1111/j.1540-8167.2006.00480.x