Influence of Left Ventricular Lead Location on Outcomes in the COMPANION Study

Authors


  • Boston Scientific sponsored the COMPANION Trial

  • L. Saxon is on the medical advisory board, is a consultant for, and receives research funds from Boston Scientific. B. Olshansky reports receiving research funds and honoraria relevant to this topic from Boston Scientific, Medtronic & St. Jude Medical. He serves as a consultant for Boston Scientific and Medtronic and reports an unspecified conflict regarding Boston Scientific. G. Tomassoni received compensation for participation in a speaker's bureau relevant to topic and serving as an advisory board member of an unspecified company. T. Guarnieri participated in a single-center research study sponsored by Guidant. P. Yong, E. Galle and J. Leigh are employees of Boston Scientific, Corp.

Address for correspondence: Leslie A. Saxon, M.D., Keck School of Medicine, University of Southern California, 1510 San Pablo Street, Suite 322, Los Angeles, CA 90033, USA. Fax: 323-442-6133; E-mail: saxon@usc.edu

Abstract

Introduction: There are no randomized controlled trial data that evaluate mortality and hospitalization rates in cardiac resynchronization therapy (CRT) recipients based on left ventricular (LV) lead location. We analyzed the event-driven outcomes of mortality and hospitalization as well as functional outcomes including Functional Class, Quality-of-Life, and 6-minute walk distance in 1,520 patients enrolled in the COMPANION study of CRT versus optimal medical therapy.

Methods and Results: Over a mean follow-up after implantation of 16.2 months, patients randomized to CRT, regardless of lead location, experienced benefit compared with optimized pharmacologic therapy (OPT), with respect to all-cause mortality or heart failure hospitalization. All but a posterior location showed benefit with respect to the all-cause mortality or all-cause hospitalization outcome. Mortality benefit in CRT-D patients was indifferent to LV lead position. All functional outcomes including 6-minute walk distance, Quality-of-Life (QOL) and Functional Class improved with CRT, regardless of LV lead location.

Conclusion: LV lead location was not a major determinant of multiple measures of response to CRT therapy in the COMPANION Trial. While acute data indicate that a left lateral LV lead location results in the most favorable hemodynamic response, these chronic data suggest that positioning an LV lead in an anterior rather than a lateral or posterior LV location has similar benefit.

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