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Impact of left ventricular lead position on the incidence of ventricular arrhythmia and clinical outcome in patients with cardiac resynchronization therapy

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Abstract

Purpose

The aim of the study was to evaluate the incidence of ventricular arrhythmia and clinical outcome in patients receiving a cardiac resynchronization therapy (CRT) depending on the left ventricular (LV) lead position.

Methods

A total of 187 consecutive patients with advanced heart failure who received a CRT-implantable cardioverter defibrillator were analyzed. Forty patients (21%) had a LV lead in the anterior/apical (anterior) and 147 patients (79%) in the posterior/posterolateral (posterior) region. The total median follow-up time was 644 days.

Results

The incidence of ventricular arrhythmia was 35% in patients with an anterior LV lead versus 30% in patients with a posterior LV lead (p = 0.53). The 1- and 2-year mortality in the anterior LV lead group was 19% and 22%, as compared with 0.7% and 3.2%, respectively, in the posterior LV lead group (p < 0.001). In a multivariable analysis, an anterior LV lead was independently associated with an increased mortality (hazard ratio 5.88, 95% confidence interval 2.22–16.67). The major cause of death was end-stage heart failure whereas the incidence of sudden cardiac death was not different between both groups.

Conclusions

Thus, biventricular pacing with an anterior LV lead seems to have no impact on the incidence of ventricular arrhythmia but may be associated with an increased mortality rate due to worsening heart failure.

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Abbreviations

CRT:

Cardiac resynchronization therapy

CRT-D:

Cardiac resynchronization therapy - implantable cardioverter defibrillator

ICD:

Implantable cardioverter defibrillator

LV:

Left ventricular

LVEDD:

Left ventricular end-diastolic dimension

NYHA:

New York Heart Association

VT:

Ventricular tachycardia

VF:

Ventricular fibrillation

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Conflict of Interest

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Authors and Affiliations

  1. Cardiac Arrhythmia Center at the Heart Center of Ludwigshafen, Bremserstraße 79, 67063, Ludwigshafen, Germany

    Thomas Kleemann, Torsten Becker, Margit Strauss, Ngoc Dyck, Udo Weisse, Werner Saggau & Karlheinz Seidl

  2. Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany

    Steffen Schneider

  3. Diagnostic and Interventional Radiology, Klinikum Ludwigshafen, Academic Teaching Hospital of Johannes-Gutenberg-University of Mainz, Ludwigshafen, Germany

    Bernd Cornelius & Günter Layer

Authors
  1. Thomas Kleemann
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  2. Torsten Becker
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  3. Margit Strauss
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Correspondence to Thomas Kleemann.

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Kleemann, T., Becker, T., Strauss, M. et al. Impact of left ventricular lead position on the incidence of ventricular arrhythmia and clinical outcome in patients with cardiac resynchronization therapy. J Interv Card Electrophysiol 28, 109–116 (2010). https://doi.org/10.1007/s10840-010-9470-z

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  • DOI: https://doi.org/10.1007/s10840-010-9470-z

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