Abstract 12261: Non-Apical Right Ventricular Lead Location is Associated with Higher Ventricular Arrhythmia Risk in CRT-D Patients - Findings from MADIT-CRT
Background. Data on the influence of right ventricular (RV) lead location regarding clinical and arrhythmia outcomes are limited in CRT patients.
Methods. We investigated 742 CRT-D patients with adjudicated RV lead location who were enrolled in MADIT-CRT to evaluate the impact of RV lead location on cardiac events. The primary end point was heart failure (HF) or death; secondary end points included ventricular tachycardia (VT), ventricular fibrillation (VF) or death; and VT or VF.
Results: Fifty-eight patients had the RV lead positioned at the RV septum, 28 patients at the RV outflow tract (RVOT), combined as RV non-apical group; while 656 patients had RV apical lead location adjudicated by X-rays and venograms from device implantation. There was no difference in the primary end point in patients with non-apical vs. apical RV lead location (HR=0.92, 95% CI: 0.51-1.64, p= 0.77). The echocardiographic response was similar across RV lead location groups (p>0.05 for LVEDV, LVESV, LAV percent change). RV non-apical lead location was associated with significantly higher incidence of VT/VF/Death (p=0.04) and VT/VF (Figure). After adjustment for clinical covariates, RV non-apical lead location showed a trend towards higher risk of VT/VF/Death (HR=1.39, 95% CI: 0.93-2.08, p=0.11) and significantly higher risk of VT/VF (HR=1.59, 95% CI: 1.02-2.44, p= 0.04). Respective results for LBBB patients were for VT/VF/Death: HR=1.55, 95% CI: 1.02-2.37, p=0.04; and for VT/VF: HR=1.73, 95% CI: 1.10-2.72, p=0.02. The risk of events was predominantly increased in the first year after device implantation (VT/VF/Death: HR=2.22, 95% CI: 0.88-3.80, p=0.004; VT/VF: HR=2.46, 95% CI: 1.41-4.33, p=0.002).
Conclusions: In CRT-D patients, RV non-apical lead location is associated with increased risk of ventricular arrhythmias, especially in patients with LBBB during the first year after implantation.
- © 2012 by American Heart Association, Inc.