ajay shah, rawa sarji, olga kuteyeva, sripal bangalore, ganesh kamath, sandhya K. balaram, jonathan steinberg, farooq chaudhry.
st.luke's-roosevelt hospital center, new york, NY, USA.
Background
Robotically implanted CRT is a rescue therapy for pts with failed endovascular implants with advantage to place left ventricular (LV) lead over the latest dyssynchronous myocardial region. The value of concordance of dyssynchrony and LV lead fixation site in improving response to CRT in these pts. is not defined.
Methods:30 pts (67±12yrs; 53%male; LVEF 18±6 % ) with end-stage heart failure , LVEF 120ms and LBBB were included. LV dyssynchrony (DYS) was defined as > 65ms opposing LV wall delay in peak systolic contraction by Tissue Synchronization Imaging. CON was defined if site of most delayed contraction and robotic LV lead fixation were same. Responders were defined by improvement in LVEF of >15 % from baseline during follow-up of 8 ± 3 mos.
Results 22 pts (73%) had dyssynchrony. 17 pts (56%) had CON, of whom 15 (88%) were responders, compared to discordance in 13 (44%), of whom 6. (46%; p= 0.001) were responders.Uni and multivariate analysis showed that concordance is a strong predictor of response to CRT {OR=36; p=0.003}. In pts. with no concordance the LVEF changed from 16±4 to 22±16 (p = 0.2) compared to pts with concordance in whom the LVEF changed from 19±6 vs. 31±12 (p <0.0001).
Conclusion:Concordance results in improved outcome after robotically-assisted CRT. Direct epicardial LV lead placement is an effective alternative to transvenous placement, and may offer superior opportunity to achieve concordance, a hypothesis that should be tested in clinical trials.
Back to 2008 Annual Meeting
Back to Program Outline