Share This Article:

Implant Electrical Characteristics Predict Response to Cardiac Resynchronization Therapy

Abstract Full-Text HTML Download Download as PDF (Size:4191KB) PP. 513-521
DOI: 10.4236/wjcd.2014.410062    2,987 Downloads   3,681 Views   Citations

ABSTRACT

Background: The optimal site for left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) remains uncertain. Intra-procedural measures for predicting response to CRT have shown mixed results. Hypothesis: This study analyzed intracardiac electrogram (IEGM) characteristics at implant and assessed patients’ response rates (RR) to CRT. Methods: Forty-one consecutive patients undergoing CRT were enrolled. Medically optimized patients in sinus rhythm, with ejection fraction (EF) < 35%, and a dyssynchrony index (DI) > 34 were included. Right ventricular (RV) leads were positioned mid-septum. LV leads were targeted to the latest mechanical activation on echocardiography. IEGMs were measured, assessing intrinsic RV-to-LV delay (int RV-LV), RV-paced delay (RVp-LV), and LV-paced delay (LVp-RV). The difference between LVp-RV and RVp-LV was recorded as delta-LV. Response was defined as improvement of EF > 10%, reduction in LVEDD > 15% and improvement of ≥1 NYHA class. Results: Overall RR was 79%. LV leads were placed in the target location in 91%. Int RV-LV was 101 ± 14 ms in responders; 78 ± 11 ms in non-responders (p < 0.05). Int RV-LV > 100 had a RR of 87%; int RV-LV < 100 had a RR of 68%. LVp-RV and RVp-LV did not differ significantly between responders and non-responders. Delta-LV > 40 ms had a RR of 56%; delta-LV < 40 ms had a RR of 85%. There was no significant correlation between lead position, DI, QRS duration or EF and IEGM measurements. Conclusions: IEGM measures at implant are easily obtained. Significant intrinsic electrical delay and shorter delta-LV both predict response, even when LV leads are implanted in the targeted mechanically-delayed segment. These assessments of electrical dyssynchrony may be used to determine optimal lead positions and response to CRT.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

Lin, T. , Crosby, P. , Sugumar, H. , Spencer, R. , Flannery, M. and O’Donnell, D. (2014) Implant Electrical Characteristics Predict Response to Cardiac Resynchronization Therapy. World Journal of Cardiovascular Diseases, 4, 513-521. doi: 10.4236/wjcd.2014.410062.

References

[1] Abraham, W.T., Fisher, W.G. and Smith, A.L. (2002) Cardiac Resynchronization in Chronic Heart Failure. The New England Journal of Medicine, 346, 1845-1853.
http://dx.doi.org/10.1056/NEJMoa013168
[2] Young, J.B., Abraham, W.T. and Smith, A.L. (2003) Combined Cardiac Resynchronization and Implantable Cardioversion Defibrillation in Advanced Chronic Heart Failure: The MIRACLE ICD Trial. Journal of the American Medical Association, 289, 2685-2694.
http://dx.doi.org/10.1001/jama.289.20.2685
[3] Bristow, M.R., Saxon, L.A., Boehmer, J., Krueger, S., Kass, D.A., De Marco, T., et al. (2004) Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure. The New England Journal of Medicine, 350, 2140-2150.
http://dx.doi.org/10.1056/NEJMoa032423
[4] Cleland, J.G.F., Daubert, J.-C., Erdmann, E., Freemantle, N., Gras, D., Kappenberger, L., et al. (2005) The Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart Failure. The New England Journal of Medicine, 352, 1539-1549.
http://dx.doi.org/10.1056/NEJMoa050496
[5] Chung, E.S., Leon, A.R., Tavazzi, L., Sun, J.-P., Nihoyannopoulos, P., Merlino, J., et al. (2008) Results of the Predictors of Response to CRT (PROSPECT) trial. Circulation, 117, 2608-2616.
http://dx.doi.org/10.1161/CIRCULATIONAHA.107.743120
[6] Moss, A.J., Hall, W.J., Cannom, D.S., Klein, H., Brown, M.W., Daubert, J.P., et al. (2009) Cardiac-Resynchronization Therapy for the Prevention of Heart-Failure Events. The New England Journal of Medicine, 361, 1329-1338.
http://dx.doi.org/10.1056/NEJMoa0906431
[7] Dong, Y.-X., Powell, B.D., Asirvatham, S.J., Friedman, P.A., Rea, R.F., Webster, T.L., et al. (2012) Left Ventricular Lead Position for Cardiac Resynchronization: A Comprehensive Cinegraphic, Echocardiographic, Clinical, and Survival Analysis. Europace, 14, 1139-1147.
http://dx.doi.org/10.1093/europace/eus045
[8] McMurray, J.J.V., Adamopoulos, S., Anker, S.D., Auricchio, A., Bohm, M., Dickstein, K., et al. (2012) ESC Guidelines for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in Collaboration with the Heart Failure Association (HFA) of the ESC. European Heart Journal, 33, 1787-1847.
[9] Bax, J.J., Bleeker, G.B., Marwick, T.H., Molhoek, S.G., Boersma, E., Steendijk, P., et al. (2004) Left Ventricular Dyssynchrony Predicts Response and Prognosis after Cardiac Resynchronization Therapy. Journal of the American College of Cardiology, 44, 1834-1840.
http://dx.doi.org/10.1016/j.jacc.2004.08.016
[10] Gorcsan, J., Oyenuga, O., Habib, P.J., Tanaka, H., Adelstein, E.C., Hara, H., et al. (2010) Relationship of Echocardiographic Dyssynchrony to Long-Term Survival after Cardiac Resynchronization Therapy. Circulation, 122, 1910-1918.
http://dx.doi.org/10.1161/CIRCULATIONAHA.110.954768
[11] Tanaka, H., Nesser, H.J., Buck, T., Oyenuga, O., Jánosi, R.A., Winter, S., et al. (2010) Dyssynchrony by Speckle-Tracking Echocardiography and Response to Cardiac Resynchronization Therapy: Results of the Speckle Tracking and Resynchronization (STAR) Study. European Heart Journal, 31, 1690-1700.
http://dx.doi.org/10.1093/eurheartj/ehq213
[12] Hara, H., Oyenuga, O.A., Tanaka, H., Adelstein, E.C., Onishi, T., McNamara, D.M., et al. (2012) The Relationship of QRS Morphology and Mechanical Dyssynchrony to Long-Term Outcome Following Cardiac Resynchronization Therapy. European Heart Journal, 33, 2680-2691.
http://dx.doi.org/10.1093/eurheartj/ehs013
[13] Sassone, B., Gabrieli, L., Saccà, S., Boggian, G., Fusco, A., Pratola, C., et al. (2010) Value of Right Ventricular-Left Ventricular Interlead Electrical Delay to Predict Reverse Remodelling in Cardiac Resynchronization Therapy: The Inter-V Pilot Study. Europace, 12, 78-83.
http://dx.doi.org/10.1093/europace/eup347
[14] Zucchelli, G., Soldati, E., Di Cori, A., De Lucia, R., Segreti, L., Solarino, G., et al. (2010) Role of Intraoperative Electrical Parameters in Predicting Reverse Remodelling after Cardiac Resynchronization Therapy and Correlation with Interventricular Mechanical Dyssynchrony. Europace, 12, 1453-1459.
http://dx.doi.org/10.1093/europace/euq267
[15] Kristiansen, H.M., Hovstad, T., Vollan, G., Keilegavlen, H. and Faerestrand, S. (2012) Clinical Implication of Right Ventricular to Left Ventricular Interlead Sensed Electrical Delay in Cardiac Resynchronization Therapy. Europace, 14, 986-993.
http://dx.doi.org/10.1093/europace/eur429
[16] Singh, J.P., Fan, D., Heist, E.K., Alabiad, C.R., Taub, C., Reddy, V., et al. (2006) Left Ventricular Lead Electrical Delay Predicts Response to Cardiac Resynchronization Therapy. Heart Rhythm, 3, 1285-1292.
http://dx.doi.org/10.1016/j.hrthm.2006.07.034
[17] Russo, A.M., Stainback, R.F., Bailey, S.R., Epstein, A.E., Heidenreich, P.A., Jessup, M., et al. (2013) ACCF/HRS/ AHA/ASE/HFSA/ SCAI/SCCT/SCMR 2013 Appropriate Use Criteria for Implantable Cardioverter-Defibrillators and Cardiac Resynchronization Therapy: A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, Heart Rhythm Society, American Heart Association, American Society of Echocardiography, Heart Failure Society of America, Society for Cardiovascular Angiography and Interventions, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. Heart Rhythm, 10, e11-e58.
[18] Yu, C.M., Fung, J.W.H., Zhang, Q., Chan, C.K., Chan, Y.S., Lin, H., et al. (2004) Tissue Doppler Imaging Is Superior to Strain Rate Imaging and Postsystolic Shortening on the Prediction of Reverse Remodeling in both Ischemic and Nonischemic Heart Failure after Cardiac Resynchronization Therapy. Circulation, 110, 66-73.
http://dx.doi.org/10.1161/01.CIR.0000133276.45198.A5
[19] Kearney, L.G., Wai, B., Ord, M., Burrell, L.M., O’Donnell, D. and Srivastava, P.M. (2011) Validation of Rapid Automated Tissue Synchronization Imaging for the Assessment of Cardiac Dyssynchrony in Sinus and Non-Sinus Rhythm. Europace, 13, 270-276.
http://dx.doi.org/10.1093/europace/euq442
[20] Wai, B., Kearney, L.G., Burrell, L.M., Ord, M. and Srivastava, P.M. (2012) Normalization of Ejection Fraction in Subjects with Systolic Heart Failure. Is It Really Normal? A Myocardial Deformation Study. International Journal of Cardiology, 154, 365-367.
http://dx.doi.org/10.1016/j.ijcard.2011.11.036
[21] Kearney, L.G., Lu, K., Ord, M., Patel, S.K., Profitis, K., Matalanis, G., et al. (2012) Global Longitudinal Strain Is a Strong Independent Predictor of All-Cause Mortality in Patients with Aortic Stenosis. European Heart Journal, Cardiovascular Imaging, 13, 827-833.
http://dx.doi.org/10.1093/ehjci/jes115
[22] Gold, M.R., Birgersdotter-Green, U., Singh, J.P., Ellenbogen, K.A., Yu, Y., Meyer, T.E., et al. (2011) The Relationship between Ventricular Electrical Delay and Left Ventricular Remodelling with Cardiac Resynchronization Therapy. European Heart Journal, 32, 2516-2524.
http://dx.doi.org/10.1093/eurheartj/ehr329
[23] Díaz-Infante, E., Mont, L., Leal, J., García-Bolao, I., Fernández-Lozano, I., Hernández-Madrid, A., et al. (2005) Predictors of Lack of Response to Resynchronization Therapy. The American Journal of Cardiology, 95, 1436-1440.
[24] Ruschitzka, F., Abraham, W.T., Singh, J.P., Bax, J.J., Borer, J.S., Brugada, J., et al. (2013) Cardiac-Resynchronization Therapy in Heart Failure with a Narrow QRS Complex. The New England Journal of Medicine, 369, 1395-1405.
http://dx.doi.org/10.1056/NEJMoa1306687
[25] Saba, S., Marek, J., Schwartzman, D., Jain, S., Adelstein, E., White, P., et al. (2013) Echocardiography-Guided Left Ventricular Lead Placement for Cardiac Resynchronization Therapy: Results of the Speckle Tracking Assisted Resynchronization Therapy for Electrode Region Trial. Circulation: Heart Failure, 6, 427-434.
http://dx.doi.org/10.1161/CIRCHEARTFAILURE.112.000078
[26] Khan, F.Z., Virdee, M.S., Palmer, C.R., Pugh, P.J., O’Halloran, D., Elsik, M., et al. (2012) Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy: The TARGET Study: A Randomized, Controlled Trial. Journal of the American College of Cardiology, 59, 1509-1518.
http://dx.doi.org/10.1016/j.jacc.2011.12.030
[27] Wong, J.A., Yee, R., Stirrat, J., Scholl, D., Krahn, A.D., Gula, L.J., et al. (2013) Influence of Pacing Site Characteristics on Response to Cardiac Resynchronization Therapy. Circulation: Cardiovascular Imaging, 6, 542-550.
http://dx.doi.org/10.1161/CIRCIMAGING.111.000146
[28] Doring, M., Braunschweig, F., Eitel, C., Gaspar, T., Wetzel, U., Nitsche, B., et al. (2013) Individually Tailored Left Ventricular Lead Placement: Lessons from Multimodality Integration between Three-Dimensional Echocardiography and Coronary Sinus Angiogram. Europace, 15, 718-727.
http://dx.doi.org/10.1093/europace/eus396
[29] Shetty, A.K., Duckett, S.G., Ginks, M.R., Ma, Y., Sohal, M., Bostock, J., et al. (2013) Cardiac Magnetic Resonance-Derived Anatomy, Scar, and Dyssynchrony Fused with Fluoroscopy to Guide LV Lead Placement in Cardiac Resynchronization Therapy: A Comparison with Acute Haemodynamic Measures and Echocardiographic Reverse Remodelling. European Heart Journal, Cardiovascular Imaging, 14, 692-699.
http://dx.doi.org/10.1093/ehjci/jes270
[30] Ypenburg, C., Schalij, M.J., Bleeker, G.B., Steendijk, P., Boersma, E., Dibbets-Schneider, P., et al. (2006) Impact of Viability and Scar Tissue on Response to Cardiac Re-synchronization Therapy in Ischaemic Heart Failure Patients. European Heart Journal, 28, 33-41.
http://dx.doi.org/10.1093/eurheartj/ehl379
[31] Reuter, S., Garrigue, S., Barold, S.S., Jais, P., Hocini, M., Haissaguerre, M., et al. (2002) Comparison of Characteristics in Responders versus Nonresponders with Biventricular Pacing for Drug-Resistant Congestive Heart Failure. American Journal of Cardiology, 89, 346-350.
http://dx.doi.org/10.1016/S0002-9149(01)02240-8
[32] Friedman, D.J., Upadhyay, G.A., Altman, R.K., Orencole, M., Barrett, C.D., Mela, T., et al. (2013) The Anatomic and Electrical Location of the Left Ventricular Lead Predicts Ventricular Arrhythmia in Cardiac Resynchronization Therapy. Heart Rhythm, 10, 668-675.
http://dx.doi.org/10.1016/j.hrthm.2012.12.025
[33] Ypenburg, C., van Bommel, R.J., Delgado, V., Mollema, S.A., Bleeker, G.B., Boersma, E., et al. (2008) Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival after Cardiac Resynchronization Therapy. Journal of the American College of Cardiology, 52, 1402-1409.
http://dx.doi.org/10.1016/j.jacc.2008.06.046

  
comments powered by Disqus

Copyright © 2019 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.