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
; 39(3): 261-7, 2016 Mar.
Article
em En
| MEDLINE
| ID: mdl-26643821
ABSTRACT
BACKGROUND:
The impact of right ventricular (RV) lead location on clinical end points in patients undergoing cardiac resynchronization therapy (CRT) is unclear. We evaluated the impact of different RV lead locations on clinical outcome in CRT patients enrolled in the Septal Positioning of ventricular implantable cardioverter-defibrillator (ICD) Electrodes (SPICE) trial, which randomized recipients of implantable cardioverter defibrillators to apical versus midseptal RV lead positioning.METHODS:
Ninety-eight CRT recipients were included in the multicenter SPICE trial and followed for 12 months Fifty-three patients were randomized to receive an apical (A) and 45 to receive a midseptal (S) lead position. We compared echocardiographical and electrocardiographical parameters and outcome.RESULTS:
Echocardiographic response with respect to improvement of left ventricular ejection fraction (A +15.8 ± 14.6%, S +9.7 ± 12.6%, P = 0.156) and reduction of left ventricular end-diastolic diameter (A -4.2 ± 10.7 mm, S -7.5 ± 10.7 mm, P = 0.141) was comparable in apical and midseptal groups. Paced QRS width neither differed at prehospital discharge (A 129 ± 21 ms, S 135 ± 21 ms, P = 0.133) nor at 12-month follow-up (A 131 ± 23 ms, S 134 ± 28 ms, P = 0.620). No differences were found with respect to the risk of ventricular tachyarrhythmia or ICD therapy. Septal RV lead position, however, was associated with a significant longer time to a first heart failure event (P = 0.040) and a longer survival time (P = 0.019).CONCLUSIONS:
In CRT recipients, midseptal RV lead position was not superior with respect to improvement of echocardiographic parameters or paced QRS width. It did not predispose to ventricular arrhythmias or ICD therapy. The finding that midseptal lead position was associated with a longer time to first heart failure event and a longer survival time deserves further investigation.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Disfunção Ventricular Esquerda
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Eletrodos Implantados
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Insuficiência Cardíaca
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Ventrículos do Coração
Tipo de estudo:
Clinical_trials
Limite:
Aged
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Female
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Humans
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Pacing Clin Electrophysiol
Ano de publicação:
2016
Tipo de documento:
Article
País de afiliação:
Alemanha