Division Clinical Electrophysiology, Department of Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
Department of Cardiology, Medical Centre, Hungarian Defence Forces, Róbert Károly krt. 44, Budapest, 1134, Hungary.
Clin Res Cardiol. 2018 Dec;107(12):1122-1130. doi: 10.1007/s00392-018-1286-3. Epub 2018 May 24.
Data on preferred ICD lead type and optimal RV lead position in patients undergoing CRT-D implantation are limited.
To compare dual- versus single-coil ICD leads and non-apical versus apical RV lead position and their impact on clinical parameters and survival in CRT-D recipients.
A total of 563 consecutive patients with advanced heart failure and indication for CRT-D implantation were enrolled in two European tertiary centers. Endpoints were improvement in NYHA functional class, changes in echo- and electrocardiographic parameters, and all-cause and cardiovascular mortality.
In this retrospective analysis, a total of 313 (56%) dual- and 250 (44%) single-coil ICD leads were used. RV leads were placed non-apically in 262 (47%) and apically in 296 (53%) patients, respectively. Over a mean follow-up of 41 ± 34 months, all-cause mortality and cardiovascular mortality were similar for patients with dual- versus single-coil ICD lead (adjusted HR 0.81, 95% CI 0.58-1.12 and aHR 1.22, 95% CI 0.73-2.04) and non-apical versus apical RV lead position (aHR 0.98, 95% CI 0.71-1.36 and aHR 0.76, 95% CI 0.44-1.31). Non-apical RV lead position was associated with greater reduction in QRS duration after CRT implantation (- 14.4 ± 32.1 vs. - 4.3 ± 34.3 ms, p < 0.001).
We found no association between ICD lead type or RV lead position and outcomes in CRT-D recipients. Non-apical RV lead position was associated with larger reduction in QRS duration.
关于接受 CRT-D 植入的患者首选 ICD 导联类型和理想 RV 导联位置的数据有限。
比较双线圈 ICD 导联与单线圈 ICD 导联以及 RV 导联非心尖部与心尖部位置，并比较其对 CRT-D 接受者临床参数和生存的影响。
共有 563 例患有晚期心力衰竭且需要 CRT-D 植入的连续患者被纳入两个欧洲三级中心。终点为 NYHA 心功能分级改善、超声心动图和心电图参数变化以及全因和心血管死亡率。
在这项回顾性分析中，共使用了 313 个（56%）双线圈 ICD 导联和 250 个（44%）单线圈 ICD 导联。RV 导联分别在心尖部和非心尖部位置放置 262 例（47%）和 296 例（53%）患者。平均随访 41±34 个月后，双线圈 ICD 导联与单线圈 ICD 导联（调整后的 HR 0.81，95%CI 0.58-1.12 和 aHR 1.22，95%CI 0.73-2.04）和 RV 导联非心尖部与心尖部位置（aHR 0.98，95%CI 0.71-1.36 和 aHR 0.76，95%CI 0.44-1.31）的全因死亡率和心血管死亡率相似。RV 导联非心尖部位置与 CRT 植入后 QRS 波持续时间的降低更大（-14.4±32.1 比-4.3±34.3 ms，p<0.001）相关。
我们没有发现 ICD 导联类型或 RV 导联位置与 CRT-D 接受者的结果之间存在关联。RV 导联非心尖部位置与 QRS 波持续时间的更大降低相关。
