TY - JOUR
T1 - Agreement on site of latest electrical activation between right ventricular pacing and intrinsic conduction as target for left ventricular lead position in cardiac resynchronization therapy
AU - Bjerre, Henrik Laurits
AU - Nielsen, Jens Cosedis
AU - Pedersen, Anders Lehmann Dahl
AU - Gerdes, Christian
AU - Kristensen, Jens
AU - Jensen, Jesper Møller
AU - Nørgaard, Bjarne Linde
AU - Kronborg, Mads Brix
PY - 2025
Y1 - 2025
N2 - Background: In cardiac resynchronization therapy (CRT), studies indicate that targeting the left ventricular (LV) lead toward the site of latest electrical activation could improve clinical outcomes. Whether this site should be determined during right ventricular (RV) pacing or intrinsic conduction is unknown. Objective: The study sought to investigate agreement between RV pacing and intrinsic conduction in identifying the site of latest electrical activation in patients undergoing CRT. Methods: During CRT implantation, we obtained pairwise measurements of the interval from QRS onset to local LV activation during intrinsic conduction (Q-LV) and the interval from the paced signal on the RV lead electrogram to the sensed local LV activation during RV pacing (RVp-LVs) in the basal, mid, and apical positions of eligible veins in patients randomized to the intervention arm in the DANISH-CRT (Does Electric Targeted LV Lead Positioning Improve Outcome in Patients With Heart Failure and Prolonged QRS) trial. Venous anatomy and final lead positions were verified by computed tomography. Results: We included 61 patients and measured intervals in 209 veins with 531segments. We found substantial agreement between RVp-LVs and Q-LV in identifying the latest activated vein (Cohen's weighted kappa coefficient 0.69 [95% confidence interval 0.62–0.76]). The RV lead was predominantly positioned toward the anteroseptal region and RVp-LVs favored a posterior vein more often than Q-LV. We found high intra- and interobserver reliability for RVp-LVs and Q-LV measurements. Conclusion: There is substantial agreement between RVp-LVs during RV pacing and Q-LV during intrinsic conduction in identifying the optimal target for LV lead position in CRT. Still, the optimal target vein changed for one-third of patients as RVp-LVs favored a posterior target vein more often than Q-LV.
AB - Background: In cardiac resynchronization therapy (CRT), studies indicate that targeting the left ventricular (LV) lead toward the site of latest electrical activation could improve clinical outcomes. Whether this site should be determined during right ventricular (RV) pacing or intrinsic conduction is unknown. Objective: The study sought to investigate agreement between RV pacing and intrinsic conduction in identifying the site of latest electrical activation in patients undergoing CRT. Methods: During CRT implantation, we obtained pairwise measurements of the interval from QRS onset to local LV activation during intrinsic conduction (Q-LV) and the interval from the paced signal on the RV lead electrogram to the sensed local LV activation during RV pacing (RVp-LVs) in the basal, mid, and apical positions of eligible veins in patients randomized to the intervention arm in the DANISH-CRT (Does Electric Targeted LV Lead Positioning Improve Outcome in Patients With Heart Failure and Prolonged QRS) trial. Venous anatomy and final lead positions were verified by computed tomography. Results: We included 61 patients and measured intervals in 209 veins with 531segments. We found substantial agreement between RVp-LVs and Q-LV in identifying the latest activated vein (Cohen's weighted kappa coefficient 0.69 [95% confidence interval 0.62–0.76]). The RV lead was predominantly positioned toward the anteroseptal region and RVp-LVs favored a posterior vein more often than Q-LV. We found high intra- and interobserver reliability for RVp-LVs and Q-LV measurements. Conclusion: There is substantial agreement between RVp-LVs during RV pacing and Q-LV during intrinsic conduction in identifying the optimal target for LV lead position in CRT. Still, the optimal target vein changed for one-third of patients as RVp-LVs favored a posterior target vein more often than Q-LV.
KW - Agreement analysis
KW - Cardiac device
KW - Cardiac resynchronization therapy
KW - CRT
KW - Heart failure
KW - RV pacing
KW - Targeted positioning
UR - http://www.scopus.com/inward/record.url?scp=105000320514&partnerID=8YFLogxK
U2 - 10.1016/j.hroo.2025.02.006
DO - 10.1016/j.hroo.2025.02.006
M3 - Journal article
AN - SCOPUS:105000320514
SN - 2666-5018
JO - Heart Rhythm O2
JF - Heart Rhythm O2
ER -