Clinical outcomes of cardiac resynchronization with epicardial left ventricular lead

Lu Chen, Haixia Fu, Victor G. Pretorius, Dachun Yang, Heather J. Wiste, Hongtao Yuan, Gregory K. Feld, Yong-Mei Cha, Ulrika M. Birgersdotter-Green

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background Left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) can be achieved via a transvenous or epicardial route. A surgically implanted epicardial LV (eLV) lead is used after a standard transvenous LV (tLV) lead implantation has failed. However, studies of clinical outcomes in patients with eLV leads and comparisons of outcome between tLV and eLV-CRT are sparse. Therefore, the purpose of this study is to compare clinical response between tLV-CRT and eLV-CRT, as well as to understand the differences within the eLV-CRT population. Methods Forty-four patients received eLV-CRT following unsuccessful attempts of tLV-CRT implantation between 2002 and 2013 at the University of California, San Diego (UCSD) and Mayo Clinics. These patients were matched for age, gender, and etiology of cardiomyopathy in a 1:2 ratio with a cohort of patients who received tLV-CRT during the same time period. Results During a mean follow-up of 57 months, similar clinical outcomes and survival rate were noted between tLV and eLV-CRT patients (all P > 0.05). Within the eLV-CRT group, dilated cardiomyopathy patients had significant improvement in New York Heart Association class and ejection fraction (both P <0.05), while ischemic cardiomyopathy patients did not (both P > 0.05). eLV-CRT patients with nonanterior lead location had significantly improved survival (P <0.001). There was also a trend for improved survival in those with nonapical lead location (P = 0.09). Conclusion In this case-matched two-centered study, comparable improvements were noted in patients with tLV-CRT and eLV-CRT. Operators should target nonanterior and nonapical locations during eLV-CRT implantation. Use of eLV-CRT should be considered a viable alternative for CRT candidates.

Original languageEnglish (US)
Pages (from-to)1201-1209
Number of pages9
JournalPACE - Pacing and Clinical Electrophysiology
Volume38
Issue number10
DOIs
StatePublished - Oct 1 2015

Fingerprint

Cardiac Resynchronization Therapy
Lead
Survival
Dilated Cardiomyopathy
Cardiomyopathies

Keywords

  • CHF
  • epicardial CRT
  • pacing
  • surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Chen, L., Fu, H., Pretorius, V. G., Yang, D., Wiste, H. J., Yuan, H., ... Birgersdotter-Green, U. M. (2015). Clinical outcomes of cardiac resynchronization with epicardial left ventricular lead. PACE - Pacing and Clinical Electrophysiology, 38(10), 1201-1209. https://doi.org/10.1111/pace.12687

Clinical outcomes of cardiac resynchronization with epicardial left ventricular lead. / Chen, Lu; Fu, Haixia; Pretorius, Victor G.; Yang, Dachun; Wiste, Heather J.; Yuan, Hongtao; Feld, Gregory K.; Cha, Yong-Mei; Birgersdotter-Green, Ulrika M.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 38, No. 10, 01.10.2015, p. 1201-1209.

Research output: Contribution to journalArticle

Chen, L, Fu, H, Pretorius, VG, Yang, D, Wiste, HJ, Yuan, H, Feld, GK, Cha, Y-M & Birgersdotter-Green, UM 2015, 'Clinical outcomes of cardiac resynchronization with epicardial left ventricular lead', PACE - Pacing and Clinical Electrophysiology, vol. 38, no. 10, pp. 1201-1209. https://doi.org/10.1111/pace.12687
Chen, Lu ; Fu, Haixia ; Pretorius, Victor G. ; Yang, Dachun ; Wiste, Heather J. ; Yuan, Hongtao ; Feld, Gregory K. ; Cha, Yong-Mei ; Birgersdotter-Green, Ulrika M. / Clinical outcomes of cardiac resynchronization with epicardial left ventricular lead. In: PACE - Pacing and Clinical Electrophysiology. 2015 ; Vol. 38, No. 10. pp. 1201-1209.
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abstract = "Background Left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) can be achieved via a transvenous or epicardial route. A surgically implanted epicardial LV (eLV) lead is used after a standard transvenous LV (tLV) lead implantation has failed. However, studies of clinical outcomes in patients with eLV leads and comparisons of outcome between tLV and eLV-CRT are sparse. Therefore, the purpose of this study is to compare clinical response between tLV-CRT and eLV-CRT, as well as to understand the differences within the eLV-CRT population. Methods Forty-four patients received eLV-CRT following unsuccessful attempts of tLV-CRT implantation between 2002 and 2013 at the University of California, San Diego (UCSD) and Mayo Clinics. These patients were matched for age, gender, and etiology of cardiomyopathy in a 1:2 ratio with a cohort of patients who received tLV-CRT during the same time period. Results During a mean follow-up of 57 months, similar clinical outcomes and survival rate were noted between tLV and eLV-CRT patients (all P > 0.05). Within the eLV-CRT group, dilated cardiomyopathy patients had significant improvement in New York Heart Association class and ejection fraction (both P <0.05), while ischemic cardiomyopathy patients did not (both P > 0.05). eLV-CRT patients with nonanterior lead location had significantly improved survival (P <0.001). There was also a trend for improved survival in those with nonapical lead location (P = 0.09). Conclusion In this case-matched two-centered study, comparable improvements were noted in patients with tLV-CRT and eLV-CRT. Operators should target nonanterior and nonapical locations during eLV-CRT implantation. Use of eLV-CRT should be considered a viable alternative for CRT candidates.",
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AU - Chen, Lu

AU - Fu, Haixia

AU - Pretorius, Victor G.

AU - Yang, Dachun

AU - Wiste, Heather J.

AU - Yuan, Hongtao

AU - Feld, Gregory K.

AU - Cha, Yong-Mei

AU - Birgersdotter-Green, Ulrika M.

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N2 - Background Left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) can be achieved via a transvenous or epicardial route. A surgically implanted epicardial LV (eLV) lead is used after a standard transvenous LV (tLV) lead implantation has failed. However, studies of clinical outcomes in patients with eLV leads and comparisons of outcome between tLV and eLV-CRT are sparse. Therefore, the purpose of this study is to compare clinical response between tLV-CRT and eLV-CRT, as well as to understand the differences within the eLV-CRT population. Methods Forty-four patients received eLV-CRT following unsuccessful attempts of tLV-CRT implantation between 2002 and 2013 at the University of California, San Diego (UCSD) and Mayo Clinics. These patients were matched for age, gender, and etiology of cardiomyopathy in a 1:2 ratio with a cohort of patients who received tLV-CRT during the same time period. Results During a mean follow-up of 57 months, similar clinical outcomes and survival rate were noted between tLV and eLV-CRT patients (all P > 0.05). Within the eLV-CRT group, dilated cardiomyopathy patients had significant improvement in New York Heart Association class and ejection fraction (both P <0.05), while ischemic cardiomyopathy patients did not (both P > 0.05). eLV-CRT patients with nonanterior lead location had significantly improved survival (P <0.001). There was also a trend for improved survival in those with nonapical lead location (P = 0.09). Conclusion In this case-matched two-centered study, comparable improvements were noted in patients with tLV-CRT and eLV-CRT. Operators should target nonanterior and nonapical locations during eLV-CRT implantation. Use of eLV-CRT should be considered a viable alternative for CRT candidates.

AB - Background Left ventricular (LV) pacing in cardiac resynchronization therapy (CRT) can be achieved via a transvenous or epicardial route. A surgically implanted epicardial LV (eLV) lead is used after a standard transvenous LV (tLV) lead implantation has failed. However, studies of clinical outcomes in patients with eLV leads and comparisons of outcome between tLV and eLV-CRT are sparse. Therefore, the purpose of this study is to compare clinical response between tLV-CRT and eLV-CRT, as well as to understand the differences within the eLV-CRT population. Methods Forty-four patients received eLV-CRT following unsuccessful attempts of tLV-CRT implantation between 2002 and 2013 at the University of California, San Diego (UCSD) and Mayo Clinics. These patients were matched for age, gender, and etiology of cardiomyopathy in a 1:2 ratio with a cohort of patients who received tLV-CRT during the same time period. Results During a mean follow-up of 57 months, similar clinical outcomes and survival rate were noted between tLV and eLV-CRT patients (all P > 0.05). Within the eLV-CRT group, dilated cardiomyopathy patients had significant improvement in New York Heart Association class and ejection fraction (both P <0.05), while ischemic cardiomyopathy patients did not (both P > 0.05). eLV-CRT patients with nonanterior lead location had significantly improved survival (P <0.001). There was also a trend for improved survival in those with nonapical lead location (P = 0.09). Conclusion In this case-matched two-centered study, comparable improvements were noted in patients with tLV-CRT and eLV-CRT. Operators should target nonanterior and nonapical locations during eLV-CRT implantation. Use of eLV-CRT should be considered a viable alternative for CRT candidates.

KW - CHF

KW - epicardial CRT

KW - pacing

KW - surgery

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