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

Research Article

Josef Kautzner¹  Dan Wichterle¹  David Horak²  Pavel Kucera²  Pavel Nedbal²  Tomas Belza²  Tomas Roubicek²  Jana Hanuliakova²  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: Cardiac resynchronization therapy;    Reverse remodelling;    LV lead location;    Electrical dyssynchrony;   

DOI  :  10.1186/1471-2261-12-34

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

来源: Springer

【 摘 要 】

BackgroundConsiderable 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.MethodsWe 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.ResultsClinical 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.ConclusionLV 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】

CC BY   
© Polasek et al.; licensee BioMed Central Ltd. 2012