Author + information
- Received May 2, 2017
- Revision received July 3, 2018
- Accepted July 12, 2018
- Published online August 29, 2018.
- Valentina Kutyifa, MD, PhDa,b,∗∗ (, )
- Annamaria Kosztin, MD, PhDb,d,∗,
- Helmut U. Klein, MDa,
- Yitschak Biton, MDc,
- Vivien Klaudia Nagy, MDb,
- Scott D. Solomon, MDd,
- Scott McNitt, MSa,
- Wojciech Zareba, MD, PhDa,
- Ilan Goldenberg, MDa,
- Attila Roka, MDc,
- Arthur J. Moss, MDa,
- Bela Merkely, MD, PhDb,∗ and
- Jagmeet P. Singh, MD, DPhilc,∗
- aUniversity of Rochester Medical Center, Rochester, New York
- bSemmelweis University, Heart Center, Budapest, Hungary
- cMassachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- dBrigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Valentina Kutyifa, Heart Research Follow-up Program, Cardiology Division, University of Rochester Medical Center, 265 Crittenden Boulevard, Box 653, Rochester, New York 14642.
Objectives The authors aimed to evaluate the association of left ventricular (LV) lead location and long-term outcomes in MADIT-CRT (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy).
Background There is limited data on the association of lead location with long-term clinical outcomes in patients with cardiac resynchronization therapy with defibrillator (CRT-D).
Methods The LV lead location was classified in 797 patients with CRT-D, in 569 patients with left bundle branch block (LBBB), in 228 patients with non-LBBB, and in 505 patients with an implantable cardioverter-defibrillator (ICD) only. Leads were classified into apical (n = 83) and non-apical (n = 486); with the non-apical LV leads further categorized into anterior (n = 99) and posterior/lateral (n = 387) within LBBB. All-cause mortality and heart failure (HF) events were assessed using Kaplan-Meier and Cox analyses.
Results In CRT-D patients with LBBB and posterior/lateral LV lead location, there was an association with a significant reduction in long-term all-cause mortality (hazard ratio [HR]: 0.54, 95% confidence interval [CI]: 0.37 to 0.79, p = 0.001), and HF events (HR: 0.44, 95% CI: 0.33 to 0.60, p < 0.001) compared to an ICD only, accompanied with better LV reverse remodeling. CRT-D patients with LBBB and an anterior LV lead location were shown to be associated with a significant reduction in HF events compared to an ICD only (anterior HR: 0.50, 95% CI: 0.30 to 0.82, p = 0.006); however, no association with mortality reduction was observed from CRT-D versus an ICD only. CRT-D was not associated with improved outcomes in non-LBBB patients, regardless of LV lead location.
Conclusions In mild HF patients with LBBB and an implanted CRT-D, lateral/posterior, and anterior LV lead locations are similarly associated with reduction in the risk of HF or death events compared to ICD alone. Mortality benefit derived from CRT-D is associated only with patients with lateral/posterior LV lead location. An apical LV lead location should be avoided due to the early risk of death whenever possible. (Multicenter Automatic Defibrillator Implantation With Cardiac Resynchronization Therapy [MADIT-CRT], NCT00180271; Multicenter Automatic Defibrillator Implantation Trial With Cardiac Resynchronization Therapy Post Approval Registry [MADIT-CRT-PAR], NCT01294449; and MADIT-CRT Long-Term International Follow-Up Registry – Europe, NCT02060110)
↵∗ Drs. Kutyifa, Kosztin, Merkely, and Singh contributed equally to this sub-study.
The MADIT-CRT study was supported by a research grant from Boston Scientific, St. Paul, Minnesota, to the University of Rochester School of Medicine and Dentistry. Dr. Kutyifa has received grants from Boston Scientific and ZOLL Inc.; and has received honoraria from Biotronik, and ZOLL Inc. Dr. Klein has received grants from Boston Scientific and Zoll; and has received personal fees from Zoll. Dr. Solomon has received grants from Boston Scientific. Dr. Zareba has received grants from Boston Scientific. Dr. Moss has received grants from Boston Scientific. Dr. Merkeley has received grants from Boston Scientific; and has received personal fees from Medtronic, Biotronik, and St. Jude Medical. Dr. Singh has received personal fees from St. Jude Medical, Boston Scientific, Medtronic, and Sorin. All other authors have reported that they have no relationships relevant to the content of this paper to report.
Angelo Auricchio, MD, served as Guest Editor for this paper.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received May 2, 2017.
- Revision received July 3, 2018.
- Accepted July 12, 2018.
- 2018 American College of Cardiology Foundation
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