Left ventricular electrical delay predicts volumetric response to leadless Cardiac Resynchronization Therapy.

BACKGROUND

Leadless left ventricular (LV) endocardial pacing is an emerging cardiac resynchronization therapy (CRT) technology. Predictors of response to leadless CRT are poorly understood. Implanting the LV endocardial pacing electrode in sites with increased electrical latency (Q-LV) may improve response rates.

OBJECTIVE

To examine the association between Q-LV and echocardiographic remodelling response to leadless CRT delivered with the WiSE-CRT system.

METHODS

A post-hoc analysis (n=122) of the SOLVE-CRT trial examined the relationship between LV pacing site Q-LV with rate of LV end-systolic volume (LVESV) reduction >15% at 6 months. Multivariable regression analysis, adjusting for age, sex, prior CRT non-response, cardiomyopathy aetiology, QRS morphology and QRS duration was performed, followed by ROC analysis and analysis of variance by Q-LV quartile. A subgroup analysis of the ischaemic cardiomyopathy cohort was undertaken.

RESULTS

Complete Q-LV data was available in 122/153 (80%) of patients in the active arms SOLVE-CRT. Overall, the 6-month LVESV response rate was 46%. Logistic regression identified Q-LV as an independent response predictor with borderline significance (adjusted odds ratio 1.015, p=0.05). Analysis by Q-LV quartile demonstrated a significant improvement in response rate in quartile 4 (longest Q-LV, 64%) compared to quartile 1 (shortest Q-LV, 28%), p<0.01. This association was primarily driven by strong Q-LV-response correlation in patients with ischaemic cardiomyopathy, demonstrated by subgroup logistic regression (adjusted odds ratio 1.034, p=0.004).

CONCLUSION

Increased Q-LV was associated with improved reverse remodelling following leadless CRT. Targeting LV endocardial sites of high Q-LV may deliver additional benefit compared to empirical LV electrode implantation.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.