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Lead Site Linked to Prognosis in Heart Failure

Pacing at site of latest mechanical activation shown superior to discordant left ventricular lead position

WEDNESDAY, Oct. 15 (HealthDay News) -- Positioning the left ventricular (LV) pacing lead in cardiac resynchronization therapy at the site of latest mechanical activation led to a superior long-term prognosis, according to research published in the Oct. 21 issue of the Journal of the American College of Cardiology.

Claudia Ypenburg, M.D., of Leiden University Medical Center in Leiden, the Netherlands, and colleagues analyzed data from 244 patients with advanced heart failure and depressed LV ejection fraction who underwent cardiac resynchronization therapy. In 153 patients, the LV lead position was located in the latest activated region (concordant), and in 91 patients the LV lead position was discordant.

Concordant LV lead position was associated with significant LV reverse remodeling, but the other patients showed no significant improvements, the investigators found. Over a mean of 32 months of follow-up, the patients in the concordant group showed fewer heart failure hospitalizations, cardiac transplantations and deaths, the researchers report.

These findings "should encourage us in the ongoing search for an optimal marker of synchrony that can be used in patient selection to help solve the riddle of cardiac resynchronization therapy response," write the authors of an accompanying editorial. "The increase in prevalence of heart failure and the expense of this modality certainly justify the need for a sequence of careful investigations that will evaluate myocardial viability, the site of maximal dyssynchrony, and the venous anatomy, to ensure that patients who have a device implanted are likely to enjoy a clinical and physiologic response."

Several of the study co-authors disclosed financial relationships with medical equipment companies, as did an editorial author.

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