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European Heart Journal Advance Access originally published online on January 25, 2007
European Heart Journal 2007 28(4):450-456; doi:10.1093/eurheartj/ehl469
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Cardiac resynchronization therapy: predictive factors of unsuccessful left ventricular lead implant

Alfonso Macías1, Ignacio García-Bolao2, Ernesto Díaz-Infante1, Jose María Tolosana1, Bárbara Vidal1, Juan José Gavira2, Antonio Berruezo1, Josep Brugada1 and Lluis Mont1,*

1 Thorax Institute, Hospital Clinic Universitari de Barcelona, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Barcelona, Spain
2 Department of Cardiology and Cardiovascular Surgery, Clinica Universitaria, Universidad de Navarra, Pamplona, Spain

Received 7 February 2006; revised 18 December 2006; accepted 21 December 2006; online publish-ahead-of-print 25 January 2007.

* Corresponding author. Tel: +34 932275551; Fax: +34 934513045. E-mail address: lmont{at}clinic.ub.es

Aims Cardiac resynchronization therapy is an established therapy for advanced heart failure. However, coronary sinus access and pacing is not achieved in about 5–10% of patients. The aim of this study was to identify predictive factors for failure of left ventricular (LV) lead transvenous implant.

Methods and results We evaluated 212 consecutive patients who received a cardiac resynchronization system. In 26 patients (12.3%), the attempt to pace the LV was unsuccessful. At univariate analysis, in patients with an unsuccessful implant a higher proportion of permanent atrial fibrillation (AF), valvular heart disease, and previous heart surgery were observed. Anteroposterior, longitudinal, and transversal left atrium diameters (LAD) were also larger among patients with an unsuccessful implant. The anteroposterior LAD (APLAD) with an optimal value to predict implant failure was 48.5 mm. At logistic regression analysis, the presence of permanent AF and APLAD were independent predictors of failed implant (OR 7.7, 95% CI 2.5–23.9, P = 0.002 and OR 11.7, 95% CI 3.1–37.6, P < 0.001, respectively).

Conclusion The presence of permanent AF and APLAD are factors that predict unsuccessful pacing from the LV.

Key Words: Heart failure • Resynchronization therapy • Coronary sinus • Unsuccessful implant


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