Local electrogram delay recorded from left ventricular lead at implant predicts response to cardiac resynchronization therapy: Retrospective study with 1 year follow up

BMC Cardiovascular Disorders

Josef Kautzner¹  Dan Wichterle¹  David Horak²  Jana Hanuliakova²  Tomas Belza²  Tomas Roubicek²  Pavel Nedbal²  Pavel Kucera²  Rostislav Polasek² 

[1] Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague, Czech Republic;Department of Cardiology, Regional Hospital Liberec, Husova 10, Liberec, Czech Republic

关键词: Electrical dyssynchrony;    LV lead location;    Reverse remodelling;    Cardiac resynchronization therapy;   

Others  :  1085016
DOI  :  10.1186/1471-2261-12-34

 received in 2012-03-16, accepted in 2012-04-30,  发布年份 2012

【 摘 要 】

Background

Considerable proportion of patients does not respond to the cardiac resynchronization therapy (CRT). This study investigated clinical relevance of left ventricular electrode local electrogram delay from the beginning of QRS (QLV). We hypothesized that longer QLV indicating more optimal lead placement in the late activated regions is associated with the higher probability of positive CRT response.

Methods

We conducted a retrospective, single–centre analysis of 161 consecutive patients with heart failure and LBBB or nonspecific intraventricular conduction delay (IVCD) treated with CRT. We routinely intend to implant the LV lead in a region with long QLV. Clinical response to CRT, left ventricular (LV) reverse remodelling (i.e. decrease in LV end-systolic diameter - LVESD ≥10%) and reduction in plasma level of NT-proBNP >30% at 12-month post-implant were the study endpoints. We analyzed association between pre-implant variables and the study endpoints.

Results

Clinical CRT response rate reached 58%, 84% and 92% in the lowest (≤105 ms), middle (106-130 ms) and the highest (>130 ms) QLV tertile (p < 0.0001), respectively. Longer QRS duration (p = 0.002), smaller LVESD and a non-ischemic cardiomyopathy (both p = 0.02) were also univariately associated with positive clinical CRT response. In a multivariate analysis, QLV remained the strongest predictor of clinical CRT response (p < 0.00001), followed by LVESD (p = 0.01) and etiology of LV dysfunction (p = 0.04). Comparable predictive power of QLV for LV reverse remodelling and NT-proBNP response rates was observed.

Conclusion

LV lead position assessed by duration of the QLV interval was found the strongest independent predictor of beneficial clinical response to CRT.

【 授权许可】

   
2012 Polasek et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Abraham WT, Fisher WG, Smith AL, Delurgio DB, Leon AR, Loh E, Kocovic DZ, Packer M, Clavell AL, Hayes DL, et al.: Cardiac resynchronization in chronic heart failure. N Engl J Med 2002, 346(24):1845-1853.
• [2]Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, Carson P, DiCarlo L, DeMets D, White BG, et al.: Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004, 350(21):2140-2150.
• [3]Linde C, Abraham WT, Gold MR: St John Sutton M, Ghio S, Daubert C: 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(23):1834-1843.
• [4]Cazeau S, Leclercq C, Lavergne T, Walker S, Varma C, Linde C, Garrigue S, Kappenberger L, Haywood GA, Santini M, et al.: Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med 2001, 344(12):873-880.
• [5]Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, Estes NA: Foster E, Greenberg H, Higgins SL et al: Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 2009, 361(14):1329-1338.
• [6]Birnie DH, Tang AS: The problem of non-response to cardiac resynchronization therapy. Curr Opin Cardiol 2006, 21(1):20-26.
• [7]Bleeker GB, Kaandorp TA, Lamb HJ, Boersma E, Steendijk P, de Roos A, van der Wall EE, Schalij MJ, Bax JJ: Effect of posterolateral scar tissue on clinical and echocardiographic improvement after cardiac resynchronization therapy. Circulation 2006, 113(7):969-976.
• [8]Ypenburg C, Schalij MJ, Bleeker GB, Steendijk P, Boersma E, Dibbets-Schneider P, Stokkel MP, van der Wall EE, Bax JJ: Extent of viability to predict response to cardiac resynchronization therapy in ischemic heart failure patients. J Nucl Med 2006, 47(10):1565-1570.
• [9]Egoavil CA, Ho RT, Greenspon AJ, Pavri BB: Cardiac resynchronization therapy in patients with right bundle branch block: analysis of pooled data from the MIRACLE and Contak CD trials. Heart Rhythm 2005, 2(6):611-615.
• [10]Bilchick KC, Kamath S, DiMarco JP, Stukenborg GJ: Bundle-branch block morphology and other predictors of outcome after cardiac resynchronization therapy in Medicare patients. Circulation 2010, 122(20):2022-2030.
• [11]Nery PB, Ha AC, Keren A, Birnie DH: Cardiac resynchronization therapy in patients with left ventricular systolic dysfunction and right bundle branch block: a systematic review. Heart Rhythm 2011, 8(7):1083-1087.
• [12]Wilton SB, Shibata MA, Sondergaard R, Cowan K, Semeniuk L, Exner DV: Relationship between left ventricular lead position using a simple radiographic classification scheme and long-term outcome with resynchronization therapy. J Interv Card Electrophysiol 2008, 23(3):219-227.
• [13]Peichl P, Kautzner J, Cihak R, Bytesnik J: The spectrum of inter- and intraventricular conduction abnormalities in patients eligible for cardiac resynchronization therapy. Pacing Clin Electrophysiol 2004, 27(8):1105-1112.
• [14]Vardas PE, Auricchio A, Blanc JJ, Daubert JC, Drexler H, Ector H, Gasparini M, Linde C, Morgado FB, Oto A, et al.: Guidelines for cardiac pacing and cardiac resynchronization therapy. the task force for cardiac pacing and cardiac resynchronization therapy of the european society of cardiology. developed in collaboration with the european heart rhythm association. Europace 2007, 9(10):959-998.
• [15]Gottdiener JS, Bednarz J, Devereux R, Gardin J, Klein A, Manning WJ, Morehead A, Kitzman D, Oh J, Quinones M, et al.: American Society of Echocardiography recommendations for use of echocardiography in clinical trials. J Am Soc Echocardiogr 2004, 17(10):1086-1119.
• [16]Singh JP, Fan D, Heist EK, Alabiad CR, Taub C, Reddy V, Mansour M, Picard MH, Ruskin JN, Mela T: Left ventricular lead electrical delay predicts response to cardiac resynchronization therapy. Heart Rhythm 2006, 3(11):1285-1292.
• [17]Fatemi M, Le Gal G, Blanc JJ, Mansourati J, Etienne Y: The use of epicardial electrogram as a simple guide to select the optimal site of left ventricular pacing in cardiac resynchronization therapy. Cardiol Res Pract 2011, 2011:8. Published online ahead of print 20 February
• [18]Gold MR, Birgersdotter-Green U, Singh JP, Ellenbogen KA, Yu Y, Meyer TE, Seth M, Tchou PJ: The relationship between ventricular electrical delay and left ventricular remodelling with cardiac resynchronization therapy. Eur Heart J 2011, 32(20):2516-2524.