Implant Electrical Characteristics Predict Response to Cardiac Resynchronization Therapy


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.

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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.

Conflicts of Interest

The authors declare no conflicts of interest.


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