Alexander P Benz1, Mate Vamos1, Julia W Erath1, Peter Bogyi2, Gabor Z Duray2, Stefan H Hohnloser3. 1. Division Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. 2. Department of Cardiology, Medical Centre, Hungarian Defence Forces, Róbert Károly krt. 44, Budapest, 1134, Hungary. 3. Division Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. hohnloser@em.uni-frankfurt.de.
Abstract
BACKGROUND: Data on preferred ICD lead type and optimal RV lead position in patients undergoing CRT-D implantation are limited. OBJECTIVES: To compare dual- versus single-coil ICD leads and non-apical versus apical RV lead position and their impact on clinical parameters and survival in CRT-D recipients. METHODS: A total of 563 consecutive patients with advanced heart failure and indication for CRT-D implantation were enrolled in two European tertiary centers. Endpoints were improvement in NYHA functional class, changes in echo- and electrocardiographic parameters, and all-cause and cardiovascular mortality. RESULTS: In this retrospective analysis, a total of 313 (56%) dual- and 250 (44%) single-coil ICD leads were used. RV leads were placed non-apically in 262 (47%) and apically in 296 (53%) patients, respectively. Over a mean follow-up of 41 ± 34 months, all-cause mortality and cardiovascular mortality were similar for patients with dual- versus single-coil ICD lead (adjusted HR 0.81, 95% CI 0.58-1.12 and aHR 1.22, 95% CI 0.73-2.04) and non-apical versus apical RV lead position (aHR 0.98, 95% CI 0.71-1.36 and aHR 0.76, 95% CI 0.44-1.31). Non-apical RV lead position was associated with greater reduction in QRS duration after CRT implantation (- 14.4 ± 32.1 vs. - 4.3 ± 34.3 ms, p < 0.001). CONCLUSIONS: We found no association between ICD lead type or RV lead position and outcomes in CRT-D recipients. Non-apical RV lead position was associated with larger reduction in QRS duration.
BACKGROUND: Data on preferred ICD lead type and optimal RV lead position in patients undergoing CRT-D implantation are limited. OBJECTIVES: To compare dual- versus single-coil ICD leads and non-apical versus apical RV lead position and their impact on clinical parameters and survival in CRT-D recipients. METHODS: A total of 563 consecutive patients with advanced heart failure and indication for CRT-D implantation were enrolled in two European tertiary centers. Endpoints were improvement in NYHA functional class, changes in echo- and electrocardiographic parameters, and all-cause and cardiovascular mortality. RESULTS: In this retrospective analysis, a total of 313 (56%) dual- and 250 (44%) single-coil ICD leads were used. RV leads were placed non-apically in 262 (47%) and apically in 296 (53%) patients, respectively. Over a mean follow-up of 41 ± 34 months, all-cause mortality and cardiovascular mortality were similar for patients with dual- versus single-coil ICD lead (adjusted HR 0.81, 95% CI 0.58-1.12 and aHR 1.22, 95% CI 0.73-2.04) and non-apical versus apical RV lead position (aHR 0.98, 95% CI 0.71-1.36 and aHR 0.76, 95% CI 0.44-1.31). Non-apical RV lead position was associated with greater reduction in QRS duration after CRT implantation (- 14.4 ± 32.1 vs. - 4.3 ± 34.3 ms, p < 0.001). CONCLUSIONS: We found no association between ICD lead type or RV lead position and outcomes in CRT-D recipients. Non-apical RV lead position was associated with larger reduction in QRS duration.
Entities:
Keywords:
Apical; CRT; Dual coil; Lead position; Septal; Single coil
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