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Fluoroscopic left ventricular lead position and the long-term clinical outcome of cardiac resynchronization therapy.

Foley, Paul W X and Chalil, Shajil and Ratib, Karim and Smith, Russell E A and Prinzen, Frits and Auricchio, Angelo and Leyva, Francisco (2011) Fluoroscopic left ventricular lead position and the long-term clinical outcome of cardiac resynchronization therapy. Pacing and clinical electrophysiology : PACE, 34 (7). pp. 785-97. ISSN 1540-8159. This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs

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Official URL: http://onlinelibrary.wiley.com/doi/10.1111/j.1540-...

Abstract

BACKGROUND

To determine the effects of left ventricular (LV) lead tip position on the long-term outcome of cardiac resynchronization therapy (CRT).

SETTING

Cardiac device therapy center.

PATIENTS

Five hundred and fifty-six patients (age 70.4 ± 10.7 years [mean ± standard deviation]).

INTERVENTIONS

CRT-pacing or CRT-defibrillation device implantation.

MAIN OUTCOME MEASURES

Cardiovascular mortality and events over a maximum follow-up period of 9.1 years.

RESULTS

Hazard ratios (HRs [95% 785]797) for cardiovascular mortality, adjusted for age, gender, QRS duration, heart failure etiology, New York Heart Association class, and presence of diabetes and atrial fibrillation, were derived for LV lead tip positions in terms of veins, circumferential, and longitudinal positions with respect to the LV chamber. For vein position, these were 1.07 (0.74-1.56) for anterolateral vein position and 1.24 (0.79-1.95) for the middle cardiac vein, compared with a posterolateral vein. For circumferential lead tip position, HRs were 1.56 (0.73-3.34) for anterolateral and 1.57 (0.76-3.25) for lateral, compared with posterior positions. For longitudinal lead tip positions, HRs were 1.02 (0.72-1.46) for basal and 1.21 (0.68-2.17) for apical, compared with mid-ventricular positions. The risk of meeting the composite endpoints of cardiovascular death or hospitalizations for heart failure and death from any cause or hospitalizations for major adverse cardiovascular events was similar among the various LV lead tip positions.

CONCLUSIONS

The position of the LV lead over the LV free wall, assessed by fluoroscopy, has no influence over the long-term outcome of CRT.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NHS Evidence www.evidence.nhs.uk by using their HEFT Athens login IDs
Subjects: WG Cardiovascular system. Cardiology
Divisions: Emergency Services > Cardiology
Related URLs:
Depositing User: Mrs Caroline Tranter
Date Deposited: 02 Dec 2014 11:12
Last Modified: 02 Dec 2014 11:12
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/701

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