Open AccessCoronary sinus lead delay index for optimization of coronary sinus lead placement
Author(s) -
Koç Mevlüt,
Kaypakli Onur,
Gözübüyük Gökhan,
Yıldıray Şahin Durmus
Publication year - 2018
Publication title -
annals of noninvasive electrocardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.494
H-Index - 48
eISSN - 1542-474X
pISSN - 1082-720X
DOI - 10.1111/anec.12454
Subject(s) - medicine , cardiology , qrs complex , ejection fraction , cardiac resynchronization therapy , lead (geology) , coronary sinus , left bundle branch block , heart failure , confounding , bundle branch block , electrocardiography , logistic regression , geomorphology , geology
Aim Optimization of coronary sinus ( CS ) lead position to the latest activated left ventricular ( LV ) area is important to increase cardiac resynchronization therapy ( CRT ) response. We aimed to detect the relationship between coronary sinus lead delay index ( CSDI ) and echocardiographic, electrocardiographic response to CRT treatment. Methods We prospectively included 137 consecutive patients with heart failure ( HF ) diagnosis, QRS ≥ 120 ms, left bundle branch block ( LBBB ), New York Heart Association score ( NYHA ) II – IV , LV ejection fraction ( LVEF ) <35% and scheduled for CRT (84 male, 53 female; mean age 65.1 ± 10.1 years). Echocardiographic CRT response was defined as ≥15% reduction in LV end‐systolic volume ( LVESV ). CS lead sensing delay was calculated as the time interval from the onset of surface QRS wave to the onset of depolarization wave recorded from the CS lead by using the CS pacing lead as a bipolar electrode. CSDI was calculated by dividing the CS lead sensing delay by the QRS duration. Results LVESV reduction was associated with baseline QRS width ( r = .257, p = .002), QRS narrowing ( r = .396, p < .001), CSDI ( r = .357, p < .001), and NT ‐pro BNP ( r = −0.213, p = .022) in bivariate analysis. In logistic regression analysis, CSDI was found to be only independent parameter for predicting significant LVESV reduction (Beta = 0.318, p < .001). CSDI was also found to be significantly associated with LVEF increase ( r = .244, p = .004) and QRS narrowing ( r = .178, p = .046). Conclusion CSDI may be used as a marker to predict the favorable response to CRT . It may be useful to integrate CSDI to CRT implantation procedure in order to minimize nonresponders.