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Repositioning and optimization of left ventricular lead position in nonresponders to cardiac resynchronization therapy is associated with improved ejection fraction, lower NT-proBNP values, and fewer heart failure symptoms

BACKGROUND: Observational data suggest that an anterior or apical left ventricular (LV) position in cardiac resynchronization therapy (CRT) is associated with worse outcome and higher likelihood of “nonresponse.” It is not known whether the benefits of optimizing LV lead position in a second procedu...

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Autores principales: Borgquist, Rasmus, Mörtsell, David, Chaudhry, Uzma, Brandt, Johan, Farouq, Maiwand, Wang, Lingwei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9626901/
https://www.ncbi.nlm.nih.gov/pubmed/36340500
http://dx.doi.org/10.1016/j.hroo.2022.06.010
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author Borgquist, Rasmus
Mörtsell, David
Chaudhry, Uzma
Brandt, Johan
Farouq, Maiwand
Wang, Lingwei
author_facet Borgquist, Rasmus
Mörtsell, David
Chaudhry, Uzma
Brandt, Johan
Farouq, Maiwand
Wang, Lingwei
author_sort Borgquist, Rasmus
collection PubMed
description BACKGROUND: Observational data suggest that an anterior or apical left ventricular (LV) position in cardiac resynchronization therapy (CRT) is associated with worse outcome and higher likelihood of “nonresponse.” 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 in whom the indication for the procedure was LV lead repositioning owing to “nonresponse” 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 were 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 < .001), LV ejection fraction (+5 [interquartile range 2–11] absolute %, P = .01), QRS duration (-36 [-44 to -8], P < .001) and N-terminal pro–brain natriuretic peptide (NT-proBNP) (-615 [-2837 to +121] ng/L, P = .03). Clinical outcome was similar to a reference population with CRT (P = ns). CONCLUSION: In nonresponders 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.
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spelling pubmed-96269012022-11-03 Repositioning and optimization of left ventricular lead position in nonresponders to cardiac resynchronization therapy is associated with improved ejection fraction, lower NT-proBNP values, and fewer heart failure symptoms Borgquist, Rasmus Mörtsell, David Chaudhry, Uzma Brandt, Johan Farouq, Maiwand Wang, Lingwei Heart Rhythm O2 Clinical BACKGROUND: Observational data suggest that an anterior or apical left ventricular (LV) position in cardiac resynchronization therapy (CRT) is associated with worse outcome and higher likelihood of “nonresponse.” 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 in whom the indication for the procedure was LV lead repositioning owing to “nonresponse” 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 were 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 < .001), LV ejection fraction (+5 [interquartile range 2–11] absolute %, P = .01), QRS duration (-36 [-44 to -8], P < .001) and N-terminal pro–brain natriuretic peptide (NT-proBNP) (-615 [-2837 to +121] ng/L, P = .03). Clinical outcome was similar to a reference population with CRT (P = ns). CONCLUSION: In nonresponders 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. Elsevier 2022-06-30 /pmc/articles/PMC9626901/ /pubmed/36340500 http://dx.doi.org/10.1016/j.hroo.2022.06.010 Text en © 2022 Heart Rhythm Society. Published by Elsevier Inc. https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Clinical
Borgquist, Rasmus
Mörtsell, David
Chaudhry, Uzma
Brandt, Johan
Farouq, Maiwand
Wang, Lingwei
Repositioning and optimization of left ventricular lead position in nonresponders to cardiac resynchronization therapy is associated with improved ejection fraction, lower NT-proBNP values, and fewer heart failure symptoms
title Repositioning and optimization of left ventricular lead position in nonresponders to cardiac resynchronization therapy is associated with improved ejection fraction, lower NT-proBNP values, and fewer heart failure symptoms
title_full Repositioning and optimization of left ventricular lead position in nonresponders to cardiac resynchronization therapy is associated with improved ejection fraction, lower NT-proBNP values, and fewer heart failure symptoms
title_fullStr Repositioning and optimization of left ventricular lead position in nonresponders to cardiac resynchronization therapy is associated with improved ejection fraction, lower NT-proBNP values, and fewer heart failure symptoms
title_full_unstemmed Repositioning and optimization of left ventricular lead position in nonresponders to cardiac resynchronization therapy is associated with improved ejection fraction, lower NT-proBNP values, and fewer heart failure symptoms
title_short Repositioning and optimization of left ventricular lead position in nonresponders to cardiac resynchronization therapy is associated with improved ejection fraction, lower NT-proBNP values, and fewer heart failure symptoms
title_sort repositioning and optimization of left ventricular lead position in nonresponders to cardiac resynchronization therapy is associated with improved ejection fraction, lower nt-probnp values, and fewer heart failure symptoms
topic Clinical
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9626901/
https://www.ncbi.nlm.nih.gov/pubmed/36340500
http://dx.doi.org/10.1016/j.hroo.2022.06.010
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