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INDIVIDUALIZED ASSESSMENT IMPROVES RESULTS OF CARDIAC RESYNCHRONIZATION THERAPY
Non-Invasive Technique Targets Optimal Position for Pacemaker Leads
New Orleans, LA – In the first randomized clinical trial to report the benefits of using echocardiography – the most common non-invasive tool for diagnostic imaging of the heart – to guide placement of pacemaker leads, researchers found that a patient-tailored approach using software to analyze left ventricle function and guide placement of lead wires can significantly boost clinical benefits from pacemakers, according to research presented today at the American College of Cardiology’s 60th Annual Scientific Session. ACC.11 is the premier cardiovascular medical meeting, bringing together cardiologists and cardiovascular specialists to further advances in cardiovascular medicine.
“Optimal placement of pacemaker leads is determined by the location of cardiac scar tissue and areas of delayed heart muscle contraction, which vary considerably among patients,” said Fakhar Z. Khan, M.D., clinical research fellow, Cambridge University, Cambridge, U.K. “Our improved results with an individualized approach should change the way pacemaker leads are implanted in this population of patients.”
Researchers used speckle tracking echocardiography (STE) to conduct cardiac assessments of 220 patients scheduled for cardiac resynchronization therapy. STE is a technological advance that refines echocardiography. Several studies have confirmed that STE is a simple, inexpensive, quick and accurate way to measure strain and function in the myocardium, the muscle layer that makes the heart pump.
For the 110 patients randomly assigned to the test group, STE measurements guided placement of the lead wire implanted in the left ventricle. Leads for the control group were implanted conventionally, without reference to the STE data. The test group had better results than the control group on all clinical endpoints, including rates of response by reverse remodeling of the left ventricle, a measure of improvement in heart function (70 percent vs. 55 percent), and improvement on a standard scale for heart failure (83 percent vs. 65 percent).
Clinical results correlate with degree of success in directing the lead to the optimal site identified by STE. Across both groups, patients with a concordant lead – placed exactly at the target site − had the lowest combined rate of death from any cause and hospitalization related to heart failure (8 percent) and better results overall. That rate was doubled (16 percent) for patients with a lead adjacent to the optimal site and 4.5 times higher (36 percent) for those with a lead remote from the optimal site. A much higher proportion of patients in the test group had concordant lead placement (61 percent vs. 47 percent).
“STE software can be applied to any existing echocardiographic image at no additional risk to the patient,” Khan said. “It makes targeting of the lead feasible at any facility that’s already performing echocardiography and has the software in their system to analyze the images. That makes it widely accessible, even for small centers and non-university hospitals, where more and more pacemakers are being implanted.”
Study participants were recruited from Papworth and Addenbrooke’s Hospitals, Cambridge, U.K, and will continue to have ongoing follow-up. The study was sponsored by Papworth Hospital Foundation Trust and funded through charitable funds and the UK National Institute for Health Research.
Dr. Khan will be available to the media on Tuesday, April 5, at 12:30 p.m. CDT, in Room 338/339.
Dr. Khan will present the study, “Targeted Left Ventricular Lead Placement to Guide Cardiac Resynchronization Therapy in Patients with Heart Failure: A Randomised Prospective Study (Target Study),” on Tuesday, April 5, at 10:45 a.m. CDT, in the Joint Main Tent: La Nouvelle.
The American College of Cardiology (www.cardiosource.org) represents the majority of board-certified cardiovascular care professionals through education, research, promotion, development and application of standards and guidelines – and to influence health care policy. ACC.11 is the largest cardiovascular meeting, bringing together cardiologists and cardiovascular specialists to share the newest discoveries in treatment and prevention, while helping the ACC achieve its mission to address and improve issues in cardiovascular medicine.