ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Heart Failure and Transplantation
The Impact of Right Ventricular Lead Position on Outcomes in Cardiac Resynchronization Therapy Patients
Yanfei Wang 1
Yan Xiong 2
ChunChang Qin 3
EnRun Wang 3
Guodong Chen 3
Zhaoyan Li 3
Lingyu Zhang 3
Fengpeng Jia 3
Yijia Tang 2
1. The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
2. Sichuan Academy of Medical Sciences and Sichuan People's Hospital, Chengdu, China
3. First Affiliated Hospital of Chongqing Medical University, Chongqing, China
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Abstract
Background: The effect of right ventricular (RV) lead position on the response to cardiac resynchronization therapy (CRT) remains unclear. We evaluated the effects of different RV lead positions on electrophysiology, echocardiography, and clinical outcomes. Methods: This was a retrospective cohort study. A total of 253 patients received CRT with left ventricular (LV) leads implanted in the LV posterolateral coronary vein were included in this study. According to the position of RV lead, the patients were divided into low septal (LSP) group (141 cases), medium septal (MSP) group (36 cases), high septal (HSP) group (32 cases) and left bundle branch area pacing (LBBAP) group (44 cases). The primary endpoint included a composite of rehospitalization for heart failure (HF) and all-cause mortality, assessed using Kaplan-Meier and Cox proportional hazards analyses. Secondary endpoints included changes in CRT response, arrhythmic events, device-related complications, pacing parameters, QRS duration, and echocardiographic parameters at 12-month follow-up. Results: There were no statistically significant differences in baseline characteristics among the four groups. The non-response rate of CRT (defined as failure to achieve an increase in LVEF >10% and an improvement in NYHA class by at least 1 grade) in the LSP group (48.2%) was higher than that in the HSP group (34.4%), MSP group (16.7%) and LBBAP group (18.2%) (P<0.008), and the risk of ventricular arrhythmia was the highest (P=0.003). QRS wave shortening and LV reverse remodeling were significantly greater in MSP and LBBAP groups than in LSP and HSP groups (P<0.05). During a mean follow-up of (22.7±4.4) months, the composite endpoint of heart failure rehospitalization and all-cause death did not differ significantly among the four groups (P>0.05). Conclusion: RV middle septum or left bundle branch area pacing may improve electrical synchronization, reverse ventricular remodeling, and reduce the incidence of non-response to CRT and arrhythmia in patients with heart failure receiving CRT
Summary
Keywords
Cardiac Resynchronization Therapy, clinical outcome, efficacy, Heart Failure, Right ventricular electrode location
Received
07 October 2025
Accepted
22 January 2026
Copyright
© 2026 Wang, Xiong, Qin, Wang, Chen, Li, Zhang, Jia and Tang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Fengpeng Jia; Yijia Tang
Disclaimer
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.