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Surface electrogram-guided left ventricular lead placement improves response to cardiac resynchronization therapy [Anatol J Cardiol]
Anatol J Cardiol. 2018; 19(3): 184-191 | DOI: 10.14744/AnatolJCardiol.2018.09216  

Surface electrogram-guided left ventricular lead placement improves response to cardiac resynchronization therapy

Abdulcebbar Şipal1, Serdar Bozyel2, Müjdat Aktaş3, Emir Derviş3, Tayyar Akbulut1, Onur Argan4, Umut Çelikyurt3, Dilek Ural5, Tayfun Şahin3, Ayşen Ağır3, Ahmet Vural3
1Department of Cardiology, Van Training and Research Hospital; Van-Turkey
2Department of Cardiology, Derince Training and Research Hospital; Kocaeli-Turkey
3Department of Cardiology, Faculty of Medicine, Kocaeli University; Kocaeli-Turkey
4Department of Cardiology, Kocaeli State Hospital; Kocaeli-Turkey
5Department of Cardiology, Faculty of Medicine, Koç University; İstanbul-Turkey

Objective: Failure to select the optimal left ventricular (LV) segment for lead implantation is one of the most important causes of unresponsiveness to the cardiac resynchronization therapy (CRT). In our study, we aimed to investigate the echocardiographic and clinical benefits of LV lead implantation guided by an intraoperative 12-lead surface electrocardiogram (ECG) in patients with multiple target veins.
Methods: We included 80 [42 (62.5%) male] heart failure patients who successfully underwent CRT defibrillator (CRT-D) implantation. Patients were divided into two groups. In group 1, LV lead was positioned at the site with the shortest biventricular-paced (BiV-paced) QRS duration (QRSd), as intraprocedurally measured using surface ECG. In group 2 (control), we included patients who underwent the standard unguided CRT. ECG, echocardiogram, and functional status were evaluated before and 6 months after CRT implantation in all patients.
Results: In group 1, BiV-paced QRSd measurements were successfully performed in 112 of 120 coronary sinus branches during CRT and an LV lead was successfully placed at the optimal site in all patients. Compared with group 2, group 1 had a significantly higher rate (85% vs. 50%, p=0.02) of response (>15% reduction in LV end-systolic volume) to CRT as well as a shorter QRSd (p<0.001) and a greater QRS shortening (∆QRS) associated with CRT compared with baseline (p<0.001). The mean New York Heart Association functional class was significantly improved in both groups, and no significant differences were found in clinical response to CRT (85% vs. 70%, p=0.181).
Conclusion: Surface ECG can be used to guide LV lead placement in patients with multiple target veins for improving response to CRT. Thus, it is a safe, feasible, and economic approach for CRT-D implantation.

Keywords: cardiac resynchronization therapy, left ventricular lead placement, electrocardiogram, QRS duration, response to CRT

Abdulcebbar Şipal, Serdar Bozyel, Müjdat Aktaş, Emir Derviş, Tayyar Akbulut, Onur Argan, Umut Çelikyurt, Dilek Ural, Tayfun Şahin, Ayşen Ağır, Ahmet Vural. Surface electrogram-guided left ventricular lead placement improves response to cardiac resynchronization therapy. Anatol J Cardiol. 2018; 19(3): 184-191

Corresponding Author: Abdulcebbar Şipal, Türkiye

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