Stefan Asbach1, Carsten Lennerz2, Verena Semmler2, Christian Grebmer2, Ulrich Solzbach3, Axel Kloppe4, Norbert Klein5, Istvan Szendey6, George Andrikopoulos7, Stylianos Tzeis7, Christoph Bode1, Christof Kolb. 1. Cardiology and Angiology I, University Heart Center, Freiburg, Germany. 2. Deutsches Herzzentrum München, Klinik für Herz- und Kreislauferkrankungen, Abteilung für Elektrophysiologie, Faculty of Medicine, Technische Universität München, Munich, Germany. 3. Ostalbklinikum, Abteilung für Innere Medizin II, Aalen, Germany. 4. Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Medizinische Klinik II, Ruhr Universität Bochum, Bochum, Germany. 5. Abteilung für Kardiologie und Angiologie, Universitaetsklinikum Leipzig, Leipzig, Germany. 6. Kliniken Maria Hilf, Klinik für Kardiologie, Mönchengladbach, Germany. 7. Department of Cardiology, Henry Dunant Hospital, Athens, Greece.
Abstract
BACKGROUND: The impact of right ventricular (RV) lead location on clinical end points in patients undergoingcardiac resynchronization therapy (CRT) is unclear. We evaluated the impact of different RV lead locations on clinical outcome in CRT patients enrolled in theSeptal Positioning of ventricular implantable cardioverter-defibrillator (ICD) Electrodes (SPICE) trial, which randomized recipients of implantable cardioverter defibrillators to apical versus midseptal RV lead positioning. METHODS:Ninety-eight CRT recipients were included in the multicenter SPICE trial and followed for 12 months: Fifty-three patients were randomized to receive an apical (A) and 45 to receive a midseptal (S) lead position. We compared echocardiographical and electrocardiographical parameters and outcome. RESULTS:Echocardiographic response with respect to improvement of left ventricular ejection fraction (A: +15.8 ± 14.6%, S: +9.7 ± 12.6%, P = 0.156) and reduction of left ventricular end-diastolic diameter (A: -4.2 ± 10.7 mm, S: -7.5 ± 10.7 mm, P = 0.141) was comparable in apical and midseptal groups. Paced QRS width neither differed at prehospital discharge (A: 129 ± 21 ms, S: 135 ± 21 ms, P = 0.133) nor at 12-month follow-up (A: 131 ± 23 ms, S: 134 ± 28 ms, P = 0.620). No differences were found with respect to the risk of ventricular tachyarrhythmia or ICD therapy. Septal RV lead position, however, was associated with a significant longer time to a first heart failure event (P = 0.040) and a longer survival time (P = 0.019). CONCLUSIONS: In CRT recipients, midseptal RV lead position was not superior with respect to improvement of echocardiographic parameters or paced QRS width. It did not predispose to ventricular arrhythmias or ICD therapy. The finding that midseptal lead position was associated with a longer time to first heart failure event and a longer survival time deserves further investigation.
RCT Entities:
BACKGROUND: The impact of right ventricular (RV) lead location on clinical end points in patients undergoing cardiac resynchronization therapy (CRT) is unclear. We evaluated the impact of different RV lead locations on clinical outcome in CRT patients enrolled in the Septal Positioning of ventricular implantable cardioverter-defibrillator (ICD) Electrodes (SPICE) trial, which randomized recipients of implantable cardioverter defibrillators to apical versus midseptal RV lead positioning. METHODS: Ninety-eight CRT recipients were included in the multicenter SPICE trial and followed for 12 months: Fifty-three patients were randomized to receive an apical (A) and 45 to receive a midseptal (S) lead position. We compared echocardiographical and electrocardiographical parameters and outcome. RESULTS: Echocardiographic response with respect to improvement of left ventricular ejection fraction (A: +15.8 ± 14.6%, S: +9.7 ± 12.6%, P = 0.156) and reduction of left ventricular end-diastolic diameter (A: -4.2 ± 10.7 mm, S: -7.5 ± 10.7 mm, P = 0.141) was comparable in apical and midseptal groups. Paced QRS width neither differed at prehospital discharge (A: 129 ± 21 ms, S: 135 ± 21 ms, P = 0.133) nor at 12-month follow-up (A: 131 ± 23 ms, S: 134 ± 28 ms, P = 0.620). No differences were found with respect to the risk of ventricular tachyarrhythmia or ICD therapy. Septal RV lead position, however, was associated with a significant longer time to a first heart failure event (P = 0.040) and a longer survival time (P = 0.019). CONCLUSIONS: In CRT recipients, midseptal RV lead position was not superior with respect to improvement of echocardiographic parameters or paced QRS width. It did not predispose to ventricular arrhythmias or ICD therapy. The finding that midseptal lead position was associated with a longer time to first heart failure event and a longer survival time deserves further investigation.
Authors: Usama A Daimee; Helmut U Klein; Michael C Giudici; Wojciech Zareba; Scott McNitt; Bronislava Polonsky; Arthur J Moss; Valentina Kutyifa Journal: J Interv Card Electrophysiol Date: 2018-03-23 Impact factor: 1.900
Authors: Fatima Ali-Ahmed; Frederik Dalgaard; Nancy M Allen Lapointe; Andrzej S Kosinski; Vanessa Blumer; Daniel P Morin; Gillian D Sanders; Sana M Al-Khatib Journal: Prog Cardiovasc Dis Date: 2021-04-20 Impact factor: 8.194
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