Clinical & Experimental Cardiology
Open Access

Abstract

Pacing Inter-lead Fluoroscopic RAO and LAO Distance and Cardiac Resynchronization Therapy Response

Zoppo F, Berton A, Zerbo F, Frigato N, Michieletto M, Zanocco A, Lupo A, Bacchiega E, Brandolino G, Reimers B and Bertaglia E

Objective: The Inter-lead Distance (ILD) between the Right and Left Ventricular (RV and LV) pacing leads may play a role in Cardiac Resynchronization Therapy (CRT) response. We sought to measure the ILD during the CRT procedure in the Left and Right Anterior Oblique (LAO and RAO) fluoroscopy projections and correlated these measurements with Trans-Thoracic Echocardiographic (TTE) reverse remodeling.

The ILD was measured in the LAO and RAO projections to obtain 2 direct (LAO ILD and RAO ILD) and 1 merged bi-dimensional (LAO ILD×RAO ILD Index) body surface-normalized indexes.

Methods and results: Between January and December 2010, 48 consecutive CRT patients were enrolled (15/48, 31.2% with upgrading indications). Fourty-five patients (mean age 72.6 ± 9 years, 28 males) completed the TTE follow up at mean of 12.3 ± 7.8 months. They were divided into CRT “responders” and “non-responders” according to the combined endpoint of LV Ejection Fraction (LVEF) improvement and LV End-Systolic Volume (ESV) reduction. Twenty-five (55%) patients were classified as responders. No difference in the 3 ILD indexes was found between responders and non-responders. In the univariate analysis, non-responders patients were more frequently affected by an ischemic cardiomyopathy and by a previous anterior myocardial infarction (Table 2). In the further multivariate analysis, no variable characterized the study groups.

Conclusions: In our study, the mono and bi-dimensional ILD failed to predict a reverse remodeling in CRT patients.