Giuseppe Stabile1, Antonio D'Onofrio2, Patrizia Pepi3, Antonio De Simone4, Matteo Santamaria5, Salvatore Ivan Caico6, Antonio Rapacciuolo7, Luigi Padeletti8, Domenico Pecora9, Tiziana Giovannini10, Giuseppe Arena11, Alfredo Spotti12, Assunta Iuliano13, Emanuele Bertaglia14, Maurizio Malacrida15, Giovanni Luca Botto16. 1. Clinica Mediterranea, Napoli, Italy. Electronic address: gmrstabile@tin.it. 2. Ospedale Monaldi, Napoli, Italy. 3. Ospedale Carlo Poma, Mantova, Italy. 4. Clinica San Michele, Maddaloni, Italy. 5. Fondazione di Ricerca e Cura 'iovanni Paolo II, Università Cattolica del Sacro Cuore, Campobasso, Italy. 6. Ospedale Sant'Antonio Abate, Gallarate (VA), Italy. 7. Departments of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy. 8. Ospedale Careggi, Università di Firenze, Firenze, Italy. 9. Ospedale Poliambulanza, Brescia, Italy. 10. Ospedale Misericordia e Dolce, Prato, Italy. 11. Ospedale SS Giacomo e Cristoforo, Massa, Italy. 12. Istituti Ospitalieri, Cremona, Italy. 13. Clinica Mediterranea, Napoli, Italy. 14. Dipartimento di Scienze Cardiache, Toraciche e Vascolari, Azienda Ospedaliera di Padova, Padova, Italy. 15. Boston Scientific Italia, Milano, Italy. 16. Ospedale S'Anna, San Fermo della Battaglia (CO), Italy.
Abstract
BACKGROUND: The implantation strategy appears to play a pivotal role in determining response to cardiac resynchronization therapy (CRT). OBJECTIVE: The aim of our study was to determine the association between anatomic and electrical interlead distance and clinical outcome after CRT implantation. METHODS: We included 216 first-time CRT recipients with left bundle branch block and sinus rhythm. On implantation, the electrical interlead distance (EID), defined as the time interval between spontaneous peak R waves detected at the right ventricular (RV) and left ventricular (LV) pacing sites, was measured. The anatomic distance between the RV and LV lead tips was determined on chest radiographs. RESULTS: The mean EID was 74 ± 41 ms, and the mean horizontal corrected interlead distance (HCID) was 125 ± 73 mm. After 12 months, 87 patients (40%) displayed an improvement in their clinical composite score. The cutoff values that best predicted an improved clinical status were as follows: 84 ms for EID (area under the curve 0.59; confidence interval [CI] 0.52-0.66; P = .026) and 90 mm for HCID (area under the curve 0.62; CI 0.55-0.69; P = .004). On multivariate analysis, only EID >84 ms (hazard ratio 0.36; CI 0.14-0.89; P = .028) and HCID >90 mm (hazard ratio 0.45; CI 0.23-0.90; P = .025) were significantly associated with the composite endpoint of death or cardiovascular hospitalization. In particular, the presence of both conditions (EID <84 ms and HCID <90 mm) was associated with the highest rate of events (log-rank test P = .002). CONCLUSIONS: The interlead anatomic and electrical distance are strongly and independently associated with patient outcome after CRT implantation. The 2 measures show an additive predictive value. (CRT MORE: Cardiac Resynchronization Therapy Modular Registry; www.clinicaltrials.gov, unique identifier: NCT01573091.)
BACKGROUND: The implantation strategy appears to play a pivotal role in determining response to cardiac resynchronization therapy (CRT). OBJECTIVE: The aim of our study was to determine the association between anatomic and electrical interlead distance and clinical outcome after CRT implantation. METHODS: We included 216 first-time CRT recipients with left bundle branch block and sinus rhythm. On implantation, the electrical interlead distance (EID), defined as the time interval between spontaneous peak R waves detected at the right ventricular (RV) and left ventricular (LV) pacing sites, was measured. The anatomic distance between the RV and LV lead tips was determined on chest radiographs. RESULTS: The mean EID was 74 ± 41 ms, and the mean horizontal corrected interlead distance (HCID) was 125 ± 73 mm. After 12 months, 87 patients (40%) displayed an improvement in their clinical composite score. The cutoff values that best predicted an improved clinical status were as follows: 84 ms for EID (area under the curve 0.59; confidence interval [CI] 0.52-0.66; P = .026) and 90 mm for HCID (area under the curve 0.62; CI 0.55-0.69; P = .004). On multivariate analysis, only EID >84 ms (hazard ratio 0.36; CI 0.14-0.89; P = .028) and HCID >90 mm (hazard ratio 0.45; CI 0.23-0.90; P = .025) were significantly associated with the composite endpoint of death or cardiovascular hospitalization. In particular, the presence of both conditions (EID <84 ms and HCID <90 mm) was associated with the highest rate of events (log-rank test P = .002). CONCLUSIONS: The interlead anatomic and electrical distance are strongly and independently associated with patient outcome after CRT implantation. The 2 measures show an additive predictive value. (CRT MORE: Cardiac Resynchronization Therapy Modular Registry; www.clinicaltrials.gov, unique identifier: NCT01573091.)
Authors: Giuseppe Stabile; Valter Bianchi; Francesco Solimene; Assunta Iuliano; Quintino Parisi; Patrizia Pepi; Mario Bocchiardo; Francesco Urraro; Antonio De Simone; Roberto Ospizio; Antonio D'Onofrio Journal: J Interv Card Electrophysiol Date: 2017-08-10 Impact factor: 1.900
Authors: Stian Ross; Hans Henrik Odland; Trent Fischer; Thor Edvardsen; Lars Ove Gammelsrud; Trine Fink Haland; Richard Cornelussen; Einar Hopp; Erik Kongsgaard Journal: Open Heart Date: 2018-12-10