Left ventricular lead location and the risk of ventricular arrhythmias in the MADIT-CRT trial

Valentina Kutyifa, Wojciech Zareba, Scott McNitt, Jagmeet Singh, William Jackson Hall, Slava Polonsky, Ilan Goldenberg, David T. Huang, Bela Merkely, Paul J. Wang, Arthur J. Moss, Helmut Klein

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Aims We aimed to evaluate the influence of left ventricular (LV) lead position on the risk of ventricular tachyarrhythmias in cardiac resynchronization therapy (CRT) patients.Methods and resultsLeft ventricular (LV) lead position was evaluated by biplane coronary venograms and anterior/posterior, lateral chest X-rays in patients enrolled in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT). The LV lead location could be defined in 797 of 1089 patients (73%). The LV lead was placed at the LV apex in 110 (14%) patients, in the anterior position in 146 (18%), in the lateral position in 448 (56%), and in the posterior position in 93 (12%) patients. After adjustment for clinical covariates, lateral or posterior lead location was associated with significantly lower risk of ventricular tachycardia (VT)/ventricular fibrillation (VF) [hazard ratio (HR) = 0.57, 95% confidence interval (CI): 0.38-0.85; P = 0.006] when compared with an anterior lead location. Patients with anterior lead position had similar risk of VT/VF as patients with implantable cardioverter defibrillator (ICD)-only (HR = 1.04, 95% CI: 0.72-1.81; P = 0.837). There was no difference in the risk of mortality between posterior or lateral and anterior LV lead locations.ConclusionCardiac resynchronization therapy with posterior or lateral LV lead position is associated with decreased risk of arrhythmic events in comparison with anterior lead location and ICD-only patients. There is no evidence for increased risk of VT/VF episodes associated with CRT.

Original languageEnglish
Pages (from-to)184-190
Number of pages7
JournalEuropean heart journal
Volume34
Issue number3
DOIs
Publication statusPublished - Jan 14 2013

Keywords

  • Cardiac resynchronization therapy
  • Left ventricular lead position
  • Ventricular fibrillation
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Kutyifa, V., Zareba, W., McNitt, S., Singh, J., Hall, W. J., Polonsky, S., Goldenberg, I., Huang, D. T., Merkely, B., Wang, P. J., Moss, A. J., & Klein, H. (2013). Left ventricular lead location and the risk of ventricular arrhythmias in the MADIT-CRT trial. European heart journal, 34(3), 184-190. https://doi.org/10.1093/eurheartj/ehs334