Influence Of Left Ventricular Lead Position On Clinical Outcomes Of Cardiac Resynchronization Therapy

Objective:To explore the influence of left ventricular lead position on clinical outcomes among patients receiving cardiac resynchronization therapy(CRT).Methods:A total of 89 patients who met the indication of CRT implantation and were refractory to optimized pharmacologic therapy after 3 months or more were classified into 3 groups,anterolateral group(n=20),lateral group(n=45)and posterolateral group(n=24)according to the retrograde coronary venous angiography on left anterior oblique(LAO)view.Echocardiographic parameters and New York Heart Association(NYHA)functional class were compared before CRT procedure and 1 year after.Besides,echocardiographic parameters change,including left ventricular ejection fraction change(?LVEF),left ventricular end-systolic diameter change(?LVESD),left ventricular end-diastolic diameter change(?LVEDD)and NYHA functional class change(?NYHA)among different groups were assessed after 1 year follow-up,as well as heart failure hospitalization and mortality.Besides,long-term events free survival among three groups were also analyzed.Results:After 1 year follow-up,echocardiographic parameters including LVEF?LVESD and LVEDD and NYHA functional class were improved among each group compared with those of prior to CRT implantation(all P<0.05);Besides,the value of ?LVEF,?LVESD,?LVEDD and ?NYHA showed no statistical significance between the lateral and posterolateral group(all P>0.05),but much better than the anterolateral group(P<0.05);As to the 1 year and long-term heart failure hospitalization and mortality,the lateral and posterolateral group were comparable(P>0.05),but it was associated with a significantly increased risk in the anterolateral group(P<0.05).Conclusions:1.Echocardiographic parameters and NYHA functional class were significantly improved after 1 year CRT implantation when the left ventricular lead were placed in the anterolateral?lateral or posterolateral wall.2.Left ventricular lead placed in the lateral and posterolateral region were associated with better short and long-term clinical outcomes compared with those placed in the anterolateral wall,suggesting that the left ventricular lead position impacts the clinical outcomes of CRT.