Right ventricular lead location, right-left ventricular lead interaction, and long-term outcomes in cardiac resynchronization therapy patients

  • Usama A. Daimee
  • Helmut U. Klein
  • Michael C. Giudici
  • Wojciech Zareba
  • Scott McNitt
  • Bronislava Polonsky
  • Arthur J. Moss
  • Valentina Kutyifa
Article
  • 33 Downloads

Abstract

Background

The effects of right ventricular (RV) lead location and the combination of RV and left ventricular (LV) lead locations on long-term outcomes in patients receiving cardiac resynchronization therapy with defibrillator (CRT-D) are not well understood.

Methods

Our cohort consisted of 743 CRT-D patients from MADIT-CRT. We evaluated long-term death and combined heart failure or death (HF/death) in patients with non-apical RV vs. apical RV leads. We further assessed these long-term outcomes based on the combination of RV and LV leads, termed “RV-LV lead interaction.” Patients with non-apical RV and apical LV leads and those with apical RV and non-apical LV leads were described to have “discordant RV and LV leads.” Patients with RV and LV leads that were both non-apical or both apical were defined to have “concordant RV and LV leads.”

Results

There were no differences in death and HF/death between patients with non-apical RV vs. apical RV leads. However, patients with non-apical RV and apical LV leads had higher mortality risk, relative to those with apical RV and non-apical LV leads (HR = 4.06, 95% CI 1.73–9.53, p = 0.001) as well as those with both leads in the non-apical (HR = 3.82, 95% CI 1.33–10.98, p = 0.013) or apical (HR = 3.40, 95% CI 1.24–9.37, p = 0.018) positions. There was no difference in HF/death by RV-LV lead sub-groups.

Conclusion

Among CRT-D patients, long-term outcomes were similar for non-apical RV and apical RV leads. However, mortality risk was increased with discordant RV and LV leads, when a non-apical RV lead was combined with an apical LV lead.

Keywords

RV lead location RV-LV lead interaction Mortality Heart failure events Long-term follow-up 

Notes

Compliance with ethical standards

Conflict of interest

Drs. Klein, Zareba, Moss, and Kutyifa have received research grants from Boston Scientific.

Ethical approval

Institutional review boards approved both MADIT-CRT and the post-trial follow-up studies, and all subjects gave informed consent.

References

  1. 1.
    Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med. 2004;350:2140–50.CrossRefPubMedGoogle Scholar
  2. 2.
    Cleland JG, Daubert J-C, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005;352:1539–49.CrossRefPubMedGoogle Scholar
  3. 3.
    Linde C, Abraham WT, Gold MR, Sutton MSJ, Ghio S, Daubert C, et al. Randomized trial of cardiac resynchronization in mildly symptomatic heart failure patients and in asymptomatic patients with left ventricular dysfunction and previous heart failure symptoms. J Am Coll Cardiol. 2008;52:1834–43.CrossRefPubMedGoogle Scholar
  4. 4.
    Moss AJ, Brown MW, Cannom DS, Daubert JP, Estes M, Foster E, et al. Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy (MADIT-CRT): design and clinical protocol. Ann Noninvasive Electrocardiol. 2005;10:34–43.CrossRefPubMedGoogle Scholar
  5. 5.
    Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med. 2009;361:1329–38.CrossRefPubMedGoogle Scholar
  6. 6.
    Tang AS, Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, et al. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med. 2010;363:2385–95.CrossRefPubMedGoogle Scholar
  7. 7.
    Goldenberg I, Kutyifa V, Klein HU, Cannom DS, Brown MW, Dan A, et al. Survival with cardiac-resynchronization therapy in mild heart failure. N Engl J Med. 2014;370:1694–701.CrossRefPubMedGoogle Scholar
  8. 8.
    Cleland JG, Daubert J-C, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. Longer-term effects of cardiac resynchronization therapy on mortality in heart failure [the CArdiac REsynchronization-Heart Failure (CARE-HF) trial extension phase]. Eur Heart J. 2006;27:1928–32.CrossRefPubMedGoogle Scholar
  9. 9.
    Riedlbauchová L, Cihák R, Bytesník J, Vancura V, Frídl P, Hosková L, et al. Optimization of right ventricular lead position in cardiac resynchronisation therapy. Eur J Heart Fail. 2006;8:609–14.CrossRefPubMedGoogle Scholar
  10. 10.
    Miranda R, Nault M, Johri A, Simpson C, Michael K, Abdollah H, et al. Maximal electric separation-guided placement of right ventricular lead improves responders in cardiac resynchronization defibrillator therapy. Circ Arrhythm Electrophysiol. 2012;5:927–32.CrossRefPubMedGoogle Scholar
  11. 11.
    Miranda RI, Nault M, Simpson CS, Michael KA, Abdollah H, Baranchuk A, et al. The right ventricular septum presents the optimum site for maximal electrical separation during left ventricular pacing. J Cardiovasc Electrophysiol. 2012;23:370–4.CrossRefPubMedGoogle Scholar
  12. 12.
    Khan FZ, Salahshouri P, Duehmke R, Read PA, Pugh PJ, Elsik M, et al. The impact of the right ventricular lead position on response to cardiac resynchronization therapy. Pacing Clin Electrophysiol. 2011;34:467–74.CrossRefPubMedGoogle Scholar
  13. 13.
    Kristiansen H, Vollan G, Hovstad T, Keilegavlen H, Faerestrand S. A randomized study of haemodynamic effects and left ventricular dyssynchrony in right ventricular apical vs. high posterior septal pacing in cardiac resynchronization therapy. Eur J Heart Fail. 2012;14:506–16.CrossRefPubMedGoogle Scholar
  14. 14.
    Thébault C, Donal E, Meunier C, Gervais R, Gerritse B, Gold MR, et al. Sites of left and right ventricular lead implantation and response to cardiac resynchronization therapy observations from the REVERSE trial. Eur Heart J. 2012;33:2662–71.CrossRefPubMedGoogle Scholar
  15. 15.
    Kutyifa V, Thomsen PEB, Huang DT, Rosero S, Tompkins C, Jons C, et al. Impact of the right ventricular lead position on clinical outcome and on the incidence of ventricular tachyarrhythmias in patients with CRT-D. Heart Rhythm. 2013;10:1770–7.CrossRefPubMedGoogle Scholar
  16. 16.
    Asbach S, Lennerz C, Semmler V, Grebmer C, Solzbach U, Kloppe A, et al. Impact of the right ventricular lead position on clinical end points in CRT recipients—a subanalysis of the multicenter randomized SPICE trial. Pacing Clin Electrophysiol. 2016;39:261–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Leclercq C, Sadoul N, Mont L, Defaye P, Osca J, Mouton E, et al. Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators: the SEPTAL CRT Study. Eur Heart J. 2016;37:473–83.CrossRefPubMedGoogle Scholar
  18. 18.
    Zografos TA, Siontis KC, Jastrzebski M, Kutyifa V, Klein HU, Zareba W, et al. Apical vs. non-apical right ventricular pacing in cardiac resynchronization therapy: a meta-analysis. Europace. 2015;17:1259–66.CrossRefPubMedGoogle Scholar
  19. 19.
    Merchant F, Heist E, McCarty D, Kumar P, Das S, Blendea D, et al. Impact of segmental left ventricle lead position on cardiac resynchronization therapy outcomes. Heart Rhythm. 2010;7:639.CrossRefPubMedGoogle Scholar
  20. 20.
    Singh JP, Klein HU, Huang DT, Reek S, Kuniss M, Quesada A, et al. Left ventricular lead position and clinical outcome in the Multicenter Automatic Defibrillator Implantation Trial–Cardiac Resynchronization Therapy (MADIT-CRT) TrialClinical perspective. Circulation. 2011;123:1159–66.CrossRefPubMedGoogle Scholar
  21. 21.
    Kutyifa V, Zareba W, McNitt S, Singh J, Hall WJ, Polonsky S, Goldenberg I, Huang DT, Merkely B and Wang PJ. Left ventricular lead location and the risk of ventricular arrhythmias in the MADIT-CRT trial. Eur Heart J. 2012;ehs334.Google Scholar
  22. 22.
    Lang R, Bierig M, Devereux R, Flachskampf F, Foster E, Pellikka P, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18:1440–63.CrossRefPubMedGoogle Scholar
  23. 23.
    Knappe D, Pouleur A-C, Shah AM, Cheng S, Uno H, Hall WJ, et al. Dyssynchrony, contractile function, and response to cardiac resynchronization TherapyClinical perspective. Circ Heart Fail. 2011;4:433–40.CrossRefPubMedGoogle Scholar
  24. 24.
    Pouleur A-C, Knappe D, Shah AM, Uno H, Bourgoun M, Foster E, et al. Relationship between improvement in left ventricular dyssynchrony and contractile function and clinical outcome with cardiac resynchronization therapy: the MADIT-CRT trial. Eur Heart J. 2011;32:1720–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Haghjoo M, Bonakdar HR, Jorat MV, Fazelifar AF, Alizadeh A, Ojaghi-Haghjghi Z, et al. Effect of right ventricular lead location on response to cardiac resynchronization therapy in patients with end-stage heart failure. Europace. 2009;11:356–63.CrossRefPubMedGoogle Scholar
  26. 26.
    Chalil S, Stegemann B, Muhyaldeen S, Khadjooi K, Smith RE, Jordan PJ, et al. Intraventricular dyssynchrony predicts mortality and morbidity after cardiac resynchronization therapy: a study using cardiovascular magnetic resonance tissue synchronization imaging. J Am Coll Cardiol. 2007;50:243–52.CrossRefPubMedGoogle Scholar
  27. 27.
    Kutyifa V, Pouleur A-C, Knappe D, Al-Ahmad A, Gibinski M, Wang PJ, et al. Dyssynchrony and the risk of ventricular arrhythmias. J Am Coll Cardiol Img. 2013;6:432–44.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Usama A. Daimee
    • 1
    • 2
  • Helmut U. Klein
    • 1
    • 2
  • Michael C. Giudici
    • 1
    • 2
  • Wojciech Zareba
    • 1
    • 2
  • Scott McNitt
    • 1
    • 2
  • Bronislava Polonsky
    • 1
    • 2
  • Arthur J. Moss
    • 1
    • 2
  • Valentina Kutyifa
    • 1
    • 2
  1. 1.Heart Research Follow-Up Program and Cardiology DivisionUniversity of Rochester Medical CenterRochesterUSA
  2. 2.The University of IowaIowa CityUSA

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