In Cardiac Resynchronization Therapy, Avoid Apical Left Ventricular Lead Placement

In MADIT-CRT, cardiac resynchronization therapy (CRT) devices decreased the composite rate of heart failure (HF) hospitalization and death and improved quality of life in patients with minimally symptomatic congestive HF (JW Cardiol Sep 1 2009). Yet a substantial number of patients do not respond to CRT. Could optimizing lead placement increase CRT's efficacy? Animal models of HF and limited human data suggest that the optimal site for left ventricular (LV) pacing is the lateral wall. To test this hypothesis, investigators studied outcomes with respect to the location of the LV lead in 799 CRT recipients who participated in MADIT-CRT.

LV lead position correlated with clinical benefit; however, two findings were unexpected. First, the risk fo…