Endocardial left ventricular pacing for cardiac resynchronization: systematic review and meta-analysis
Open Access
- 1 January 2017
- journal article
- review article
- Published by Oxford University Press (OUP) in EP Europace
- Vol. 20 (1), 73-81
- https://doi.org/10.1093/europace/euw381
Abstract
Endocardial left ventricular (LV) pacing for Cardiac Resynchronization Therapy has been proposed as an alternative to conventional LV lead placement via the coronary sinus. In order to assess the relative benefits and risks of this technique, we have performed a meta-analysis of published reports. A systemic search was performed using online databases to identify studies of lead-based endocardial pacing. A random-effects meta-analysis was performed, to assess the rate of complications and clinical response (defined as ≥1 decrease in NYHA class). We selected 23 studies, including 384 patients. The trans-atrial septal technique was used in 20 studies, 1 used the trans-ventricular apical technique, and 2 used the trans-ventricular septal technique. Mean age was 66 years, male 66%, EF 26%, NYHA class 3.0. Procedural success rates were over 95% in all studies. Clinical response was reported by 16 studies for 262 patients, giving a response estimate of 82% (95% CI 71–89%). There was significant heterogeneity, and response in the only large study was 59%. Thromboembolic (TE) complications were reported by all studies, over 22 ±32 months follow up. The rate of stroke was 2.5 events per 100 patient years (95% CI 1.5–4.3), and TIA 2.6 (1.1–6.1). The mortality rate was 4.5 (1.5–13.6) per 100 patient years. LV endocardial pacing appears to be a viable technique when conventional lead placement is not possible. Response rates were heterogeneous but comparable with conventional CRT. There is likely to be a small increase over expected rates of stroke, although included patients were high risk.Keywords
Funding Information
- BHF (FS/15/8/31155)
This publication has 42 references indexed in Scilit:
- Direct Left Ventricular Endocardial Pacing: An Alternative When Traditional Resynchronization Via Coronary Sinus Is Not Feasible or EffectivePacing and Clinical Electrophysiology, 2013
- Event‐Free Survival Following CRT with Surgically Implanted LV Leads Versus Standard Transvenous ApproachPacing and Clinical Electrophysiology, 2011
- Transseptal Implantation of a Left Ventricular Pacing Lead for an Ectopic Location of the Coronary Sinus Ostium in the Left AtriumPacing and Clinical Electrophysiology, 2011
- Yoked Catheter Positioning in Transseptal Endocardial Left Ventricular Lead PlacementPacing and Clinical Electrophysiology, 2011
- Random effects meta-analysis of event outcome in the framework of the generalized linear mixed model with applications in sparse dataStatistics in Medicine, 2010
- Assessment of regression-based methods to adjust for publication bias through a comprehensive simulation studyBMC Medical Research Methodology, 2009
- Targeted left ventricular endocardial pacing using a steerable introducing guide catheter and active fixation pacing leadEP Europace, 2008
- Biventricular ICD implant using endocardial LV lead placement from the left subclavian vein approach and transseptal puncture via the transfemoral routeEP Europace, 2007
- Left Ventricular Endocardial Lead Placement Using a Modified Transseptal ApproachJournal of Cardiovascular Electrophysiology, 2004
- Left Ventricular Lead Insertion Using a Modified Transseptal Catheterization Technique: A Totally Endocardial Approach for Permanent Biventricular Pacing in End‐Stage Heart FailurePacing and Clinical Electrophysiology, 1999