Left Ventricular Lead Electrical Delay Is a Predictor of Mortality in Patients With Cardiac Resynchronization Therapy
Tomas Roubicek, Dan Wichterle, Pavel Kucera, Pavel Nedbal, Jindrich Kupec, Jana Sedlakova, Jan Cerny, Jan Stros, Josef Kautzner, Kučera
DOI: 10.1161/CIRCEP.115.003004
Klíčová slova: resynchronization; hospitalization; mortality rate, LV lead electrical delay
Anotace:
Background - Electrical left ventricular lead position, assessed by the electrical delay from theZobrazit více »
beginning of the QRS complex to the local LV electrogram (QLV), was found in previous
studies to be a strong predictor of short-term response to cardiac resynchronization therapy
(CRT). We hypothesized that suboptimum electrical position of the left ventricular lead is
associated with an excess of heart failure events and mortality.
Methods and Results - We analyzed the clinical outcome of patients with left bundle branch
block or intraventricular conduction delay treated with CRT at our institution during 9 years.
Baseline clinical characteristics, QLV/QRS duration (QLV ratio) at CRT implant, and data
concerning heart failure hospitalization and mode of death were collected in 329 patients who
were followed for a period of 3.3±1.9 years. Of them, 83 were hospitalized for heart failure and
83 died. Event rates for all-cause mortality, cardiac mortality, non-cardiac mortality, heart failure
mortality, and sudden death were 25.2%, 14.9%, 10.3%, 12.2%, and 2.1%, respectively. Patients
ZLWKD4/9UDWLRKDGVLJQLILFDQWO\ZRUVHHYHQW-free survival for all study endpoints –
hazard ratio (HR): 1.6, 95% confidence interval (CI) 1.0-2.4, P=0.05 for heart failure
hospitalization; HR: 2.9, 95 % CI 1.6-5.5, P=0.001 for heart failure mortality; HR: 1.8, 95% CI
1.1-2.7, P=0.01 for cardiac mortality; and HR: 2.1, 95% CI 1.2-3.7, P=0.01 for all-cause
mortality. In multivariable analysis, 4/9UDWLRUHPDLQHGDVVRFLDWHGZLWKDOOVWXG\
endpoints.
Conclusions - Electrical left ventricular lead position in CRT patients was a significant predictor
of heart failure hospitalization and mortality.
Key words: resyn
Citace: ROUBICEK, Tomas, Dan WICHTERLE, Pavel KUCERA, et al. Left Ventricular Lead Electrical Delay Is a Predictor of Mortality in Patients With Cardiac Resynchronization Therapy. Circulation: Arrhythmia and Electrophysiology: journal of the American Heart Association. Arrhythmia and electrophysiology. Hagerstown: Lippincott Williams and Wilkins, 2015, 8(5), 1113-1121. ISSN 1941-3149. Dostupné z: doi:10.1161/CIRCEP.115.003004