Left ventricular lead proximity to an akinetic segment and impact on outcome of cardiac resynchronization therapy.

Daniel Arzola-Castaner, Cynthia C. Taub, E. Kevin Heist, Dali Fan, Kyle Haelewyn, Theofanie Mela, Michael H. Picard, Jeremy N. Ruskin, Jagmeet P. Singh

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

BACKGROUND: Previous studies report that the optimal pacing site for cardiac resynchronization therapy (CRT) is along the left ventricular (LV) lateral and postero-lateral (PL) wall. However, little is known regarding whether pacing over an akinetic site impacts the contractile response and long-term outcome from CRT. METHODS AND RESULTS: A total of 38 patients with ischemic cardiomyopathy were studied for their acute hemodynamic and 12-month clinical response to CRT. The intraindividual percentage change in dP/dt (%DeltadP/dt), over baseline, was derived from the mitral regurgitation (MR) Doppler profile with CRT on versus off. Two-dimensional echocardiography was used for myocardial segmentation and determinination of akinetic sites. LV lead implant site was determined using angiographic and radiographic data and categorized as being "on" (group 1) or "off" (group 2) an akinetic site. Long-term response was measured as a combined endpoint of hospitalization for heart failure and/or all cause mortality at 12 months. Time to primary endpoint was estimated by the Kaplan-Meier method. Clinical characteristics and acute hemodynamic response was similar in both (group 1 [n = 14]; %DeltadP/dt 48.8 +/- 67.4% vs group 2 [n = 24]; %DeltadP/dt 32.2 +/- 40.1%, P = 0.92). No difference in long-term outcome was observed (P = 0.59). In contrast, lead placement in PL or mid-lateral (ML) positions was associated with a better acute hemodynamic response when compared to antero-lateral (AL) positions (PL, %DeltadP/dt 45.7 +/- 50.7% and ML, %DeltadP/dt 45.1 +/- 58.8% vs AL, %DeltadP/dt 2.9 +/- 30.9%, respectively, P = 0.014). CONCLUSION: LV lead proximity to an akinetic segment does not impact acute hemodynamic or 12-month clinical response to CRT.

Original languageEnglish (US)
Pages (from-to)623-627
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume17
Issue number6
DOIs
StatePublished - Jun 2006
Externally publishedYes

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Cardiac Resynchronization Therapy
Hemodynamics
Mitral Valve Insufficiency
Cardiomyopathies
Echocardiography
Hospitalization
Heart Failure
Lead
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

Left ventricular lead proximity to an akinetic segment and impact on outcome of cardiac resynchronization therapy. / Arzola-Castaner, Daniel; Taub, Cynthia C.; Kevin Heist, E.; Fan, Dali; Haelewyn, Kyle; Mela, Theofanie; Picard, Michael H.; Ruskin, Jeremy N.; Singh, Jagmeet P.

In: Journal of Cardiovascular Electrophysiology, Vol. 17, No. 6, 06.2006, p. 623-627.

Research output: Contribution to journalArticle

Arzola-Castaner, Daniel ; Taub, Cynthia C. ; Kevin Heist, E. ; Fan, Dali ; Haelewyn, Kyle ; Mela, Theofanie ; Picard, Michael H. ; Ruskin, Jeremy N. ; Singh, Jagmeet P. / Left ventricular lead proximity to an akinetic segment and impact on outcome of cardiac resynchronization therapy. In: Journal of Cardiovascular Electrophysiology. 2006 ; Vol. 17, No. 6. pp. 623-627.
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abstract = "BACKGROUND: Previous studies report that the optimal pacing site for cardiac resynchronization therapy (CRT) is along the left ventricular (LV) lateral and postero-lateral (PL) wall. However, little is known regarding whether pacing over an akinetic site impacts the contractile response and long-term outcome from CRT. METHODS AND RESULTS: A total of 38 patients with ischemic cardiomyopathy were studied for their acute hemodynamic and 12-month clinical response to CRT. The intraindividual percentage change in dP/dt ({\%}DeltadP/dt), over baseline, was derived from the mitral regurgitation (MR) Doppler profile with CRT on versus off. Two-dimensional echocardiography was used for myocardial segmentation and determinination of akinetic sites. LV lead implant site was determined using angiographic and radiographic data and categorized as being {"}on{"} (group 1) or {"}off{"} (group 2) an akinetic site. Long-term response was measured as a combined endpoint of hospitalization for heart failure and/or all cause mortality at 12 months. Time to primary endpoint was estimated by the Kaplan-Meier method. Clinical characteristics and acute hemodynamic response was similar in both (group 1 [n = 14]; {\%}DeltadP/dt 48.8 +/- 67.4{\%} vs group 2 [n = 24]; {\%}DeltadP/dt 32.2 +/- 40.1{\%}, P = 0.92). No difference in long-term outcome was observed (P = 0.59). In contrast, lead placement in PL or mid-lateral (ML) positions was associated with a better acute hemodynamic response when compared to antero-lateral (AL) positions (PL, {\%}DeltadP/dt 45.7 +/- 50.7{\%} and ML, {\%}DeltadP/dt 45.1 +/- 58.8{\%} vs AL, {\%}DeltadP/dt 2.9 +/- 30.9{\%}, respectively, P = 0.014). CONCLUSION: LV lead proximity to an akinetic segment does not impact acute hemodynamic or 12-month clinical response to CRT.",
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T1 - Left ventricular lead proximity to an akinetic segment and impact on outcome of cardiac resynchronization therapy.

AU - Arzola-Castaner, Daniel

AU - Taub, Cynthia C.

AU - Kevin Heist, E.

AU - Fan, Dali

AU - Haelewyn, Kyle

AU - Mela, Theofanie

AU - Picard, Michael H.

AU - Ruskin, Jeremy N.

AU - Singh, Jagmeet P.

PY - 2006/6

Y1 - 2006/6

N2 - BACKGROUND: Previous studies report that the optimal pacing site for cardiac resynchronization therapy (CRT) is along the left ventricular (LV) lateral and postero-lateral (PL) wall. However, little is known regarding whether pacing over an akinetic site impacts the contractile response and long-term outcome from CRT. METHODS AND RESULTS: A total of 38 patients with ischemic cardiomyopathy were studied for their acute hemodynamic and 12-month clinical response to CRT. The intraindividual percentage change in dP/dt (%DeltadP/dt), over baseline, was derived from the mitral regurgitation (MR) Doppler profile with CRT on versus off. Two-dimensional echocardiography was used for myocardial segmentation and determinination of akinetic sites. LV lead implant site was determined using angiographic and radiographic data and categorized as being "on" (group 1) or "off" (group 2) an akinetic site. Long-term response was measured as a combined endpoint of hospitalization for heart failure and/or all cause mortality at 12 months. Time to primary endpoint was estimated by the Kaplan-Meier method. Clinical characteristics and acute hemodynamic response was similar in both (group 1 [n = 14]; %DeltadP/dt 48.8 +/- 67.4% vs group 2 [n = 24]; %DeltadP/dt 32.2 +/- 40.1%, P = 0.92). No difference in long-term outcome was observed (P = 0.59). In contrast, lead placement in PL or mid-lateral (ML) positions was associated with a better acute hemodynamic response when compared to antero-lateral (AL) positions (PL, %DeltadP/dt 45.7 +/- 50.7% and ML, %DeltadP/dt 45.1 +/- 58.8% vs AL, %DeltadP/dt 2.9 +/- 30.9%, respectively, P = 0.014). CONCLUSION: LV lead proximity to an akinetic segment does not impact acute hemodynamic or 12-month clinical response to CRT.

AB - BACKGROUND: Previous studies report that the optimal pacing site for cardiac resynchronization therapy (CRT) is along the left ventricular (LV) lateral and postero-lateral (PL) wall. However, little is known regarding whether pacing over an akinetic site impacts the contractile response and long-term outcome from CRT. METHODS AND RESULTS: A total of 38 patients with ischemic cardiomyopathy were studied for their acute hemodynamic and 12-month clinical response to CRT. The intraindividual percentage change in dP/dt (%DeltadP/dt), over baseline, was derived from the mitral regurgitation (MR) Doppler profile with CRT on versus off. Two-dimensional echocardiography was used for myocardial segmentation and determinination of akinetic sites. LV lead implant site was determined using angiographic and radiographic data and categorized as being "on" (group 1) or "off" (group 2) an akinetic site. Long-term response was measured as a combined endpoint of hospitalization for heart failure and/or all cause mortality at 12 months. Time to primary endpoint was estimated by the Kaplan-Meier method. Clinical characteristics and acute hemodynamic response was similar in both (group 1 [n = 14]; %DeltadP/dt 48.8 +/- 67.4% vs group 2 [n = 24]; %DeltadP/dt 32.2 +/- 40.1%, P = 0.92). No difference in long-term outcome was observed (P = 0.59). In contrast, lead placement in PL or mid-lateral (ML) positions was associated with a better acute hemodynamic response when compared to antero-lateral (AL) positions (PL, %DeltadP/dt 45.7 +/- 50.7% and ML, %DeltadP/dt 45.1 +/- 58.8% vs AL, %DeltadP/dt 2.9 +/- 30.9%, respectively, P = 0.014). CONCLUSION: LV lead proximity to an akinetic segment does not impact acute hemodynamic or 12-month clinical response to CRT.

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