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Can J Cardiol. 2014 Apr;30(4):413-9. doi: 10.1016/j.cjca.2013.10.009. Epub 2013 Oct 18.

Left ventricular lead position and outcomes in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT).

Author information

1
Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada. Electronic address: sbwilton@ucalgary.ca.
2
Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada.
3
Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada.
4
University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
5
London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada.
6
QEII Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
7
Montreal Heart Institute, Montreal, Quebec, Canada.
8
Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
9
University of British Columbia, Vancouver, British Columbia, Canada.
10
Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
11
Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
12
Southlake Regional Health Centre, Newmarket, Ontario, Canada.

Abstract

BACKGROUND:

Conflicting data exist regarding the association between left ventricular (LV) lead position and benefit from cardiac resynchronization therapy. We evaluated the relationships between LV lead positions and the risk of death or hospitalization for heart failure (HF) in the cardiac resynchronization therapy arm of the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT).

METHODS:

LV lead position was categorized by site investigator (MD) and in a chest radiograph core laboratory (CXR) as "anterior," "lateral," or "posterior" in the short axis, and "basal," "mid," or "apical" in the long axis. Agreement between MD and CXR LV lead position classification was evaluated and the independent relationship between LV lead position and clinical outcome was assessed using Cox multivariable models.

RESULTS:

Agreement between MD and CXR LV lead position was poor (κ ≤ 0.26). Over 39 ± 20 months, 140 of 447 (31.3%) patients met the RAFT primary end point (death or HF hospitalization). In adjusted analyses, neither MD-determined nor CXR-determined anterior or apical LV lead position was significantly associated with the primary outcome. However, CXR-defined apical LV lead position was associated with a higher risk of HF hospitalization (hazard ratio, 1.99; P = 0.004).

CONCLUSIONS:

Poor agreement between implanting physician and core lab CXR-based categorizations of LV lead position was observed. Neither categorization method resulted in significant associations between apical or anterior LV lead position and the risk of the composite primary outcome of death or heart failure hospitalization. However, CXR-defined apical lead position was associated with increased risk of HF hospitalization.

PMID:
24561009
DOI:
10.1016/j.cjca.2013.10.009
[Indexed for MEDLINE]

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