Response to CRT in patient with chronic heart failure depending on the ventricular leads localization
heart failure ; cardiac resynchronization therapy
The aim of the study was to assess how the response to CRT depends on ventricle leads localization, usefulness of radiological methods in prediction response to CRT and examination influence modified stimulator’s parameters on response to CRT. 50 consequence patients after CRT implantation were enrolled to the study. Horizontal separation was larger in the group of the patients who died (9,0 ± 1.8 cm vs 8,0 ±3,2 cm, p=0,0222). Significant correlation between LV lead’s segment in AP chest X-ray and LVESV was observed (r = 0,75, p = 0,030). Significant correlation between right lead segment in AP projection and narrowing of the QRS complex as well as change of LVESV were observed (r = -0,46, p = 0,022; r = -0,74, p = 0,037, ). In the lateral chest X-ray RV lead’s segment correlated with change of the QRS complex (r = -0,51, p = 0,010). There was correlation between narrowing of the QRS complex and absolute separation (r = -0,42, p = 0,036) and horizontal separation (r = -0,41, p = 0,044). LV EF increase was larger when RV lead was located in line 2 comparising to localization in line 3 or 4 (45,12 ± 28,5% vs 18,1 ± 31,6%, p = 0,0406), whereas QRS was narrower for line 3 and 4 comparising to line 2 (-19,3 ± 13,7 ms vs -6,8 ± 10,0 ms, p = 0.0122). Mean value of the left ventricle segment was higher in patient with decreased NT-proBNP plasma concentration (13,4 ± 2,4 vs 8,3 ± 2,3, p ; =0,036). 6-MWT distance was longer in the group with increased AV-delay (22,2 ± 15,4 % vs -10,1 ±29%, p = 0,0045). Conclusion: radiological methods of localization of the ventricular leads are a useful tool in prediction response to CRT, but results are ambiguous.