Details

Autor(en) / Beteiligte

• Wilton, Stephen B., MD, MSc
• Exner, Derek V., MD, MPH
• Healey, Jeffrey S., MD, MSc
• Birnie, David, MD
• Arnold, Malcolm O., MD
• Sapp, John L., MD
• Thibault, Bernard, MD
• Simpson, Christopher S., MD
• Tung, Stanley, MD
• Crystal, Eugene, MD
• Sivakumaran, Soori, MD
• Khaykin, Yaariv, MD
• Yetisir, Elizabeth, MSc
• Wells, George, PhD
• Tang, Anthony S.L., MD, FHRS

Titel

Left Ventricular Lead Position and Outcomes in the Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT)

Ist Teil von

• Canadian journal of cardiology, 2014-04, Vol.30 (4), p.413-419

Ort / Verlag

England: Elsevier Inc

Erscheinungsjahr

2014

Quelle

MEDLINE

Beschreibungen/Notizen

• 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 R esynchronization-Defibrillation for A mbulatory Heart F ailure T rial (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.