Systematic review and meta-analysis of left ventricular endocardial pacing in advanced heart failure: Clinically efficacious but at what cost?

Abstract

INTRODUCTION:

Cardiac resynchronization using a left ventricular (LV) epicardial lead placed in the coronary sinus is now routinely used in the management of heart failure patients. LV endocardial pacing is an alternative when this is not feasible, with outcomes data sparse.

OBJECTIVE:

To review the available evidence on the efficacy and safety of endocardial LV pacing via meta-analysis.

METHODS:

EMBASE, MEDLINE, and COCHRANE databases with the search term "endocardial biventricular pacing" or "endocardial cardiac resynchronization" or "left ventricular endocardial" or "endocardial left ventricular." Comparisons of pre-and post-QRS width, LV ejection fraction (LVEF), and New York Heart Association (NYHA) functional classification was performed, and mean differences (and respective 95% confidence interval [CI]) applied as a measurement of treatment effect.

RESULTS:

Fifteen studies, including 362 patients, were selected. During a mean follow-up of 40 ± 24.5 months, death occurred in 72 patients (11 per 100 patient-years). Significant improvements in LVEF (mean difference 7.9%, 95% CI 5-10%, P < 0.0001; I2  = 73%), QRS width (mean difference: -41% 95% -75 to -7%; P < 0.0001; I2  = 94%), and NYHA class (mean difference: -1.06, 95% CI -1.2 to -0.9, P < 0.0001; I2  = 60%), (all P < 0.0001) occurred. Stroke rate was 3.3-4.2 per 100 patient-years, which is higher than equivalent heart failure trial populations and recent meta-analysis that included small case series.

CONCLUSION:

LV endocardial lead implantation is a potentially efficacious alternative to CS lead placement, but preliminary data suggest a potentially higher risk of stroke during follow-up when compared to the expected incidence of stroke in similar cohorts of patients.

• Authors: Adam J Graham, Rui Providenica, Shohreh Honarbakhsh, Neil Srinivasan, Vinit Sawhney, Ross Hunter, Pier Lambiase
• Journal: Pacing and clinical electrophysiology : PACE (Pacing Clin Electrophysiol) Vol. 41 Issue 4 Pg. 353-361 (04 2018) ISSN: 1540-8159 [Electronic] United States
• PMID: 29344950 (Publication Type: Journal Article, Meta-Analysis, Systematic Review)
• Copyright: © 2018 Wiley Periodicals, Inc.

Topics

• Cardiac Pacing, Artificial (methods)
• Cardiac Resynchronization Therapy (methods)
• Endocardium (physiopathology)
• Heart Failure (physiopathology, prevention & control)
• Humans