Impact of segmental left ventricle lead position on cardiac resynchronization therapy outcomes

Background The optimal pacing site for cardiac resynchronization therapy (CRT) is along the left ventricle (LV) lateral or posterolateral wall. However, little is known about the impact of segmental pacing site on outcomes. Objective We assessed the impact of segmental LV lead position on CRT outcomes. Methods Patients (n = 115) undergoing CRT were followed prospectively. Segmental LV lead position along the longitudinal axis (apical, midventricle, or basal) was determined retrospectively by examining coronary sinus (CS) venograms and chest X-rays. The primary outcome was a combined endpoint of heart failure hospitalization, cardiac transplantation, or all-cause mortality. Secondary outcomes included change in New York Heart Association (NYHA) functional class and degree of LV reverse remodeling. Results Patients were divided into two groups based on LV lead position: apical (n = 25) and basal/midventricle (n = 90). The apical group was older (72.9 ± 8.9 vs. 66.5 ± 13.3 years; P = .010) and more likely to have ischemic cardiomyopathy (77% vs. 52%, P