DPhil, GRB 109, Cardiac Arrhythmia Service, Massachusetts General Hospital Heart Center, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
Circulation. 2011 Mar 22;123(11):1159-66. doi: 10.1161/CIRCULATIONAHA.110.000646. Epub 2011 Mar 7.
An important determinant of successful cardiac resynchronization therapy for heart failure is the position of the left ventricular (LV) pacing lead. The aim of this study was to analyze the impact of the LV lead position on outcome in patients randomized to cardiac resynchronization-defibrillation in the Multicenter Automatic Defibrillator Implantation Trial-Cardiac Resynchronization Therapy (MADIT-CRT) study.
The location of the LV lead was assessed by means of coronary venograms and chest x-rays recorded at the time of device implantation. The LV lead location was classified along the short axis into an anterior, lateral, or posterior position and along the long axis into a basal, midventricular, or apical region. The primary end point of MADIT-CRT was heart failure (HF) hospitalization or death, whichever came first. The LV lead position was assessed in 799 patients, (55% patients ≥65 years of age, 26% female, 10% LV ejection fraction ≤25%, 55% ischemic cardiomyopathy, and 71% left bundle-branch block) with a follow-up of 29±11 months. The extent of cardiac resynchronization therapy benefit was similar for leads in the anterior, lateral, or posterior position (P=0.652). The apical lead location compared with leads located in the nonapical position (basal or midventricular region) was associated with a significantly increased risk for heart failure/death (hazard ratio=1.72; 95% confidence interval, 1.09 to 2.71; P=0.019) after adjustment for the clinical covariates. The apical lead position was also associated with an increased risk for death (hazard ratio=2.91; 95% confidence interval, 1.42 to 5.97; P=0.004).
LV leads positioned in the apical region were associated with an unfavorable outcome, suggesting that this lead location should be avoided in cardiac resynchronization therapy. Clinical Trial Registration- URL: http://clinicaltrials.gov. Unique identifier: NCT00180271.
成功进行心脏再同步治疗心力衰竭的一个重要决定因素是左心室（LV）起搏导线的位置。本研究的目的是分析多中心自动除颤器植入试验-心脏再同步治疗（MADIT-CRT）研究中随机接受心脏再同步除颤治疗的患者的 LV 起搏导线位置对结果的影响。
通过在设备植入时记录的冠状静脉造影和胸部 X 射线来评估 LV 起搏导线的位置。LV 起搏导线的位置沿短轴分为前、侧或后位置，沿长轴分为基底、中间心室或心尖区域。MADIT-CRT 的主要终点是心力衰竭（HF）住院或死亡，以先发生者为准。在 799 名患者中评估了 LV 起搏导线位置（≥65 岁患者占 55%，女性占 26%，LV 射血分数≤25%的患者占 10%，缺血性心肌病患者占 55%，左束支传导阻滞患者占 71%），随访 29±11 个月。在前、侧或后位置的起搏导线的心脏再同步治疗获益程度相似（P=0.652）。与位于非心尖位置（基底或中间心室区域）的起搏导线相比，心尖位置的起搏导线与心力衰竭/死亡风险显著增加相关（风险比=1.72；95%置信区间，1.09 至 2.71；P=0.019），校正临床协变量后。心尖位置的起搏导线也与死亡风险增加相关（风险比=2.91；95%置信区间，1.42 至 5.97；P=0.004）。
位于心尖区域的 LV 起搏导线与不良结果相关，这表明心脏再同步治疗中应避免这种起搏导线位置。临床试验注册-网址：http://clinicaltrials.gov。唯一标识符：NCT00180271。
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