Abstract 10238: Left Ventricular Lead Position and Long-Term Clinical Outcome in the RAFT Trial
Background: Anterior and apical left ventricular (LV) pacing locations have been associated with poor outcomes among patients treated with cardiac resynchronization therapy (CRT) in some studies. We performed a pre-specified evaluation of the association of LV lead position with outcome in the Resynchronization-Defibrillation for Ambulatory Heart Failure (RAFT) trial.
Methods/Results: The 447 of 894 (50%) CRT recipients in the RAFT LV lead sub-study had similar characteristics to the remaining CRT patients. LV lead position was categorized as ‘anterior’, ‘lateral’ or ‘posterior’ in the short axis and ‘basal’, ‘mid” or ‘apical’ in the long axis. Lead position was assessed using two methods: via intra-operative fluoroscopy and coronary sinus venography (implant) and via core laboratory blinded evaluation of post-implant PA and lateral chest radiographs (CXR). Agreement between the 2 methods was compared using the kappa statistic. Cox models were used to assess the independent relationship between LV lead position and death from any cause or hospitalization for heart failure (HF), the RAFT primary outcome.
Agreement between implant and CXR LV lead position was modest to poor in both the short (55.4%, kappa 0.25) and long axes (49.8%, kappa 0.15). After a follow-up of 36 ± 20 months, 137 (31%) patients died or were hospitalized for HF. Neither implant-defined (seen in 12%) nor CXR-defined (seen in 16%) anterior LV lead position was associated with altered risk of the primary outcome. Similarly, neither implant-defined (seen in 2%) nor CXR-defined (seen in 26%) apical LV lead position was associated with clinical outcome overall, but variation among patients with ischemic and non-ischemic HF was observed (see Table).
Conclusions Poor agreement between implant and blinded CXR LV lead position was found. Further, neither implant nor CXR-defined LV lead position was associated with a significant alteration in the risk of death from any cause or hospitalization for HF.
- © 2011 by American Heart Association, Inc.