ABSTRACT

Objective

Despite appropriate patient selection criteria and procedural information and technological advances, a high number of patients with cardiac resynchronization therapy (CRT) still remains nonresponsive to treatment. In this study, it was aimed to investigate the relation between the distance between the middle cardiac vein (MCV) and the placement of the left ventricular (LV) lead and the response to CRT implantation.

Material and Methods

Angiographic and clinical data of a total of 53 patients were analyzed retrospectively.

Patients were divided into two separate groups as responders and non-responders according to the benefit of CRT after at least six months of clinical follow-up. The distance between the coronary sinus (CS) branch where the LV lead was placed and the MCV ostium was measured, and the relation between this distance and response to CRT was examined.

Results

Mean age of the patients was 63.53 ± 11.11 years, and 19 (35.8%) patients were females. Ischemic etiology was significantly higher in the non-responders group than in the responder group [14 patients (41.2%) vs 13 patients (72.2%), p= 0.031]. The distance from MCV to the tributary where LV lead was placed was not statistically different between the groups (44.8 ± 18.3 mm vs. 37.8 ± 17.3 mm; p= 0.531); however, this distance was significantly correlated with the reduction of hospitalization after implantation of the CRT.

Conclusion

In general, the recommended target for the location of the LV lead in CRT implantation is the lateral and posterior tributaries of the CS, nevertheless this issue has not been clearly clarified. In this study, we found that the distance between the LV lead tributary and MCV may be associated with a decrease in the frequency of hospitalization due to heart failure.