Author + information
- Received January 31, 2020
- Revision received May 12, 2020
- Accepted May 12, 2020
- Published online August 12, 2020.
- Rasmus Borgquist, MD, PhDa,∗ (, )
- Marcus Carlsson, MD, PhDb,
- Hanna Markstad, MDc,
- Anna Werther-Evaldsson, MScd,
- Ellen Ostenfeld, MD, PhDb,c,
- Anders Roijer, MD, PhDd and
- Zoltan Bakos, MD, PhDa
- aCardiology Division, Arrhythmia Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
- bClinical Physiology Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
- cRadiology Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
- dHeart Failure and Valvular Heart Disease Section, Skane University Hospital, Lund, Sweden
- ↵∗Address for correspondence:
Dr. Rasmus Borgquist, Arrhythmia Section, Cardiology, Arrhythmia Section, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Entrégatan 5, S - 222 42 Lund, Sweden.
Objectives This study evaluated if selecting the left ventricular (LV) target segment by echocardiography-derived late mechanical activation, with access to multimodality imaging for scar and venous anatomy, could help to increase responder rates to cardiac resynchronization therapy (CRT).
Background LV lead placement is important for clinical outcome, but the optimal strategy for LV lead placement in CRT is still debated.
Methods This study conducted a prospective, blinded randomized controlled trial on 102 patients with indication for CRT (27% women, 46% with ischemic cardiomyopathy, 63% in New York Heart Association functional class III, 74% with left bundle branch block, and with mean ejection fraction of 23%). Optimal LV lead location was defined as the latest mechanically activated available segment (free of transmural scar), determined by radial strain echocardiography, cardiac computed tomography, and cardiac magnetic resonance (n = 70). The primary endpoint was reduction of LV end-systolic volume by ≥15% at 6 months post-implantation.
Results Patients were followed for 47 ± 21 months. Based on imaging, optimal or adjacent lead placement was feasible in 96% of all cases and was obtained in 83% of the intervention group versus 80% of the control group. Fifty-six percent of the patients were LV end-systolic volume responders compared with the control group (55%) (p = 0.96), and 71% improved ≥1 New York Heart Association functional class (74% vs. 67%; p = 0.43). Death or heart failure hospitalization within 2 years occurred in 6% (2% of the intervention group vs. 10% of the control group; p = 0.07).
Conclusions Radial strain-guided LV lead placement, in combination with multimodality imaging, did not result in increased clinical or echocardiographic response, nor in a significant reduction of death or heart failure hospitalization. (Combining Myocardial Strain and Cardiac CT to Optimize Left Ventricular Lead Placement in CRT Treatment [CRT Clinic]; NCT01426321)
- cardiac CT
- cardiac MRI
- cardiac resynchronization therapy
- heart failure
- left ventricular lead position
- multimodality imaging
This study was funded by grants from Skane University Hospital donation funds, regional funds within the Swedish health care system (ALF), regional research grants within the Skane Region, and the Crafoord Foundation. Dr. Borgquist has received speaker fees from Abbott and Medtronic. Dr. Carlsson has received consultancy fees from Imacor AB. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The 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 January 31, 2020.
- Revision received May 12, 2020.
- Accepted May 12, 2020.
- 2020 American College of Cardiology Foundation
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