Repositioning and optimization of left ventricular lead position in non-responders to Cardiac Resynchronization Therapy is associated with improved ejection fraction, lower NT-ProBNP values and less heart failure symptoms

Research output: Contribution to journalArticlepeer-review

Abstract

Background
Observational data suggests that an anterior or apical left ventricular (LV) position in Cardiac Resynchronization Therapy (CRT) is associated with worse outcome and higher likelihood of “non-response”. It is not known whether the benefits of optimizing LV lead position in a second procedure outweighs the procedural risks.
Objective
To evaluate the clinical effects of LV lead repositioning.
Methods
During the period 2015-2020, we identified all patients where the indication for the procedure was LV lead repositioning due to “non-response” in combination with suboptimal LV lead position. All patients were followed with a structured visit 6-months post LV lead revision. Heart failure hospitalization and mortality data was gathered from the medical records and cross-checked with the population registry.
Results
A total of 25 patients were identified who fulfilled the inclusion criteria. All procedures were successful in establishing LV lead pacing in a lateral mid- or basal location. Median follow-up was 2.5 years [1.1-3.7]. There were improvements in NYHA class (mean -0.5±0.5 class, p<0.001), left ventricular ejection fraction (+5 [IQR 2-11] absolute %, p=0.01), QRS duration (-36 [-44 to -8], p<0.001) and NT-ProBNP (-615 [-2837 to +121] ng/L, p=0.03). Clinical outcome was similar to a reference population with CRT (p=ns).
Conclusion
In non-responders to CRT with either an anterior or inferior LV lead position, it was feasible to perform LV lead repositioning in all cases, with a low complication rate. Changing the LV lead position was associated with improved LV ejection fraction, larger QRS-reduction and larger NT-ProBNP reduction.
Original languageEnglish
Pages (from-to)457-463
JournalHeart Rhythm O2
Volume3
Issue number5
Early online date2022 Jun 27
DOIs
Publication statusPublished - 2022

Subject classification (UKÄ)

  • Cardiac and Cardiovascular Systems

Fingerprint

Dive into the research topics of 'Repositioning and optimization of left ventricular lead position in non-responders to Cardiac Resynchronization Therapy is associated with improved ejection fraction, lower NT-ProBNP values and less heart failure symptoms'. Together they form a unique fingerprint.

Cite this