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Left Ventricular Lead Electrical Delay Is a Predictor of Mortality in Patients With Cardiac Resynchronization Therapy
T. Roubicek, D. Wichterle, P. Kucera, P. Nedbal, J. Kupec, J. Sedlakova, J. Cerny, J. Stros, J. Kautzner, R. Polasek,
Language English Country United States
Document type Journal Article
NLK
Free Medical Journals
from 2008 to 1 year ago
Open Access Digital Library
from 2008-04-01
- MeSH
- Bundle-Branch Block mortality physiopathology therapy MeSH
- Humans MeSH
- Survival Rate MeSH
- Predictive Value of Tests MeSH
- Heart Conduction System abnormalities physiopathology MeSH
- Cardiac Resynchronization Therapy Devices * MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Arrhythmias, Cardiac mortality physiopathology therapy MeSH
- Heart Ventricles physiopathology MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
BACKGROUND: Electric left ventricular lead position, assessed by the electric delay from the 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. We hypothesized that suboptimum electric 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 cardiac resynchronization therapy at our institution during 9 years. Baseline clinical characteristics, QLV/QRS duration (QLV ratio) at cardiac resynchronization therapy implant, and data about 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, noncardiac mortality, heart failure mortality, and sudden death were 25.2%, 14.9%, 10.3%, 12.2%, and 2.1%, respectively. Patients with a QLV ratio ≤0.70 had significantly worse event-free survival for all study end points--hazard ratio, 1.6; 95% confidence interval, 1.0 to 2.4; P=0.05 for heart failure hospitalization; hazard ratio, 2.9; 95% confidence interval, 1.6 to 5.5; P=0.001 for heart failure mortality; hazard ratio, 1.8; 95% confidence interval, 1.1 to 2.7; P=0.01 for cardiac mortality; and hazard ratio, 2.1; 95% confidence interval, 1.2 to 3.7; P=0.01 for all-cause mortality. In multivariable analysis, QLV ratio ≤0.70 remained associated with all study end points. CONCLUSIONS: Electric left ventricular lead position in cardiac resynchronization therapy patients was a significant predictor of heart failure hospitalization and mortality.
Department of Cardiology Institute for Clinical and Experimental Medicine Prague Czech Republic
From the Department of Cardiology Regional Hospital Liberec Liberec Czech Republic
Institute of Health Studies Technical University of Liberec Liberec Czech Republic
References provided by Crossref.org
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- $a Roubicek, Tomas $u From the Department of Cardiology, Regional Hospital Liberec, Liberec, Czech Republic (T.R., P.K., P.N., J. Kupec, J. Sedlakova, J.C., J. Stros, R.P.); Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic (D.W., J. Kautzner); and Institute of Health Studies, Technical University of Liberec, Liberec, Czech Republic (D.W., J. Kautzner, R.P.). tomas.roubicek@nemlib.cz.
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- $a Left Ventricular Lead Electrical Delay Is a Predictor of Mortality in Patients With Cardiac Resynchronization Therapy / $c T. Roubicek, D. Wichterle, P. Kucera, P. Nedbal, J. Kupec, J. Sedlakova, J. Cerny, J. Stros, J. Kautzner, R. Polasek,
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- $a BACKGROUND: Electric left ventricular lead position, assessed by the electric delay from the 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. We hypothesized that suboptimum electric 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 cardiac resynchronization therapy at our institution during 9 years. Baseline clinical characteristics, QLV/QRS duration (QLV ratio) at cardiac resynchronization therapy implant, and data about 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, noncardiac mortality, heart failure mortality, and sudden death were 25.2%, 14.9%, 10.3%, 12.2%, and 2.1%, respectively. Patients with a QLV ratio ≤0.70 had significantly worse event-free survival for all study end points--hazard ratio, 1.6; 95% confidence interval, 1.0 to 2.4; P=0.05 for heart failure hospitalization; hazard ratio, 2.9; 95% confidence interval, 1.6 to 5.5; P=0.001 for heart failure mortality; hazard ratio, 1.8; 95% confidence interval, 1.1 to 2.7; P=0.01 for cardiac mortality; and hazard ratio, 2.1; 95% confidence interval, 1.2 to 3.7; P=0.01 for all-cause mortality. In multivariable analysis, QLV ratio ≤0.70 remained associated with all study end points. CONCLUSIONS: Electric left ventricular lead position in cardiac resynchronization therapy patients was a significant predictor of heart failure hospitalization and mortality.
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