Left Ventricular Lead Location and Long-Term Outcomes in Cardiac Resynchronization Therapy Patients

Valentina Kutyifa, Annamaria Kosztin, Helmut U. Klein, Yitschak Biton, Vivien Klaudia Nagy, Scott D. Solomon, Scott McNitt, Wojciech Zareba, Ilan Goldenberg, Attila Roka, Arthur J. Moss, B. Merkely, Jagmeet P. Singh

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Abstract

Objectives: The authors aimed to evaluate the association of left ventricular (LV) lead location and long-term outcomes in MADIT-CRT (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy). Background: There is limited data on the association of lead location with long-term clinical outcomes in patients with cardiac resynchronization therapy with defibrillator (CRT-D). Methods: The LV lead location was classified in 797 patients with CRT-D, in 569 patients with left bundle branch block (LBBB), in 228 patients with non-LBBB, and in 505 patients with an implantable cardioverter-defibrillator (ICD) only. Leads were classified into apical (n = 83) and non-apical (n = 486); with the non-apical LV leads further categorized into anterior (n = 99) and posterior/lateral (n = 387) within LBBB. All-cause mortality and heart failure (HF) events were assessed using Kaplan-Meier and Cox analyses. Results: In CRT-D patients with LBBB and posterior/lateral LV lead location, there was an association with a significant reduction in long-term all-cause mortality (hazard ratio [HR]: 0.54, 95% confidence interval [CI]: 0.37 to 0.79; p = 0.001), and HF events (HR: 0.44, 95% CI: 0.33 to 0.60; p < 0.001) compared to an ICD only, accompanied with better LV reverse remodeling. CRT-D patients with LBBB and an anterior LV lead location were shown to be associated with a significant reduction in HF events compared to an ICD only (anterior HR: 0.50, 95% CI: 0.30 to 0.82; p = 0.006); however, no association with mortality reduction was observed from CRT-D versus an ICD only. CRT-D was not associated with improved outcomes in non-LBBB patients, regardless of LV lead location. Conclusions: In mild HF patients with LBBB and an implanted CRT-D, lateral/posterior, and anterior LV lead locations are similarly associated with reduction in the risk of HF or death events compared to ICD alone. Mortality benefit derived from CRT-D is associated only with patients with lateral/posterior LV lead location. An apical LV lead location should be avoided due to the early risk of death whenever possible. (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy [MADIT-CRT], NCT00180271; Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy Post Approval Registry [MADIT-CRT-PAR], NCT01294449; and MADIT-CRT Long-Term International Follow-Up Registry – Europe, NCT02060110)

Original languageEnglish
Pages (from-to)1410-1420
Number of pages11
JournalJACC: Clinical Electrophysiology
Volume4
Issue number11
DOIs
Publication statusPublished - Nov 1 2018

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Keywords

  • cardiac resynchronization therapy
  • long-term outcomes
  • LV lead

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Kutyifa, V., Kosztin, A., Klein, H. U., Biton, Y., Nagy, V. K., Solomon, S. D., McNitt, S., Zareba, W., Goldenberg, I., Roka, A., Moss, A. J., Merkely, B., & Singh, J. P. (2018). Left Ventricular Lead Location and Long-Term Outcomes in Cardiac Resynchronization Therapy Patients. JACC: Clinical Electrophysiology, 4(11), 1410-1420. https://doi.org/10.1016/j.jacep.2018.07.006