Right ventricular lead positioning does not influence the benefits of cardiac resynchronization therapy in patients with heart failure and atrial fibrillation

Rönn, Folke; Kesek, Milos; Karp, Kjell; Henein, Michael Y.; Jensen, Steen M.

doi:10.1093/europace/eur193

Cited by 12 publications

(6 citation statements)

References 24 publications

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“…We retrieved 82 citations from electronic database and manual searches as shown in Figure . We reviewed 16 citations for full‐text articles; 7 full‐text articles were included in the final analysis . Four of the included studies were post hoc analyses of the RCTs and one was randomized crossover trial .…”

Section: Resultsmentioning

confidence: 99%

“…We reviewed 16 citations for fulltext articles; 7 full-text articles were included in the final analysis. [17][18][19][20][21][22][23] Four of the included studies were post hoc analyses of the RCTs [19][20][21][22] and one was randomized crossover trial. 21 All the included studies were published between 2011 and 2016.…”

Section: Description Of Individual Studiesmentioning

confidence: 99%

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Clinical and echocardiographic response of apical vs nonapical right ventricular lead position in CRT: A meta‐analysis

Sharma

Dahal

Dominic

et al. 2018

Journal of Arrhythmia

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BackgroundTraditionally the right ventricular (RV) pacing lead is placed in the RV apex in cardiac resynchronization therapy (CRT). It is not clear whether nonapical placement of the RV lead is associated with a better response to CRT. We aimed to perform a meta‐analysis of all randomized controlled trials (RCTs) that compared apical and nonapical RV lead placement in CRT.MethodsWe searched PubMed, EMBASE, Cochrane, Scopus, and relevant references for studies and performed meta‐analysis using random effects model. Our main outcome measures were all‐cause mortality, composite of death and heart failure hospitalization, improvement in ejection fraction (EF), left ventricle end‐diastolic volume (LVEDV), left ventricle end‐systolic volume (LVESV), and adverse events.ResultsSeven RCTs with a total population of 1641 patients (1199 apical and 492 nonapical) were included in our meta‐analysis. There was no difference in all‐cause mortality (5% vs 4.3%, odds ratio (OR) = 0.86; 95% confidence interval (CI) 0.45‐1.64; P = .65; I 2 = 11%) and a composite of death and heart failure hospitalization (14.2% vs 12.9%, OR = 0.92; 95% CI: 0.61‐1.38; P = .68; I 2 = 0) between apical and nonapical groups. No difference in improvement in EF (Weighted mean difference (WMD) = 0.37; 95% CI: −2.75‐3.48; P = .82; I 2 = 68%), change in LVEDV (WMD = 3.67; 95% CI: −4.86‐12.20; P = .40; I 2 = 89%) and LVESV (WMD = −1.20; 95% CI: −4.32‐1.91; P = .45; I 2 = 0) were noted between apical and nonapical groups. Proportion of patients achieving >15% improvement in EF was similar in both groups (OR = 0.85; 95% CI: 0.62‐1.16; P = .31; I 2 = 0).ConclusionIn patients with CRT, nonapical RV pacing is not associated with improved clinical and echocardiographic outcomes compared with RV apical pacing.

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Section: Resultsmentioning

confidence: 99%

Section: Description Of Individual Studiesmentioning

confidence: 99%

Clinical and echocardiographic response of apical vs nonapical right ventricular lead position in CRT: A meta‐analysis

Sharma

Dahal

Dominic

et al. 2018

Journal of Arrhythmia

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“…Reprinted with permission of Europace. clinical effects, as demonstrated recently in a prospective crossover study [47]. To date, the studies studying the role of septal position were either retrospective or too [OK] low powered to demonstrate any significant effect [44,45,47].…”

Section: Role Of Rv Lead Position In Patients In Crt Populationmentioning

confidence: 99%

Focus on right ventricular outflow tract septal pacing

Costa

Laurent

Romeyer‐Bouchard

et al. 2013

Archives of Cardiovascular Diseases

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Experimental and clinical studies have shown that right ventricular apical pacing may result in long-term deleterious effects on account of its negative impact on left ventricular remodeling through desynchronization. This risk appears more pronounced in patients with even moderate left ventricular dysfunction and generally occurs after at least 1 year of pacing. As right ventricular apical pacing may be associated with the development of organic mitral insufficiency, other sites that allow for more physiological stimulation, such as right ventricular outflow tract septal pacing, have been developed, with good feasibility and reproducibility. However, the prospective randomized studies and meta-analyses to date have only demonstrated a modest effect on ejection fraction in the medium term, without any significant effect on quality of life and morbimortality. However, the absence of a favorable effect for right ventricular outflow tract septal pacing compared with right ventricular apical pacing in terms of clinical manifestations and patient prognosis appears to be more associated with the designs of these studies, which were not homogeneous with regard to methodology used, judgment criteria, follow-up and, especially, statistical power. Two randomized prospective multicentre studies are currently ongoing in order to evaluate the favorable effect of infundibular septal pacing, when considering the indirect negative effects of right ventricular apical pacing as reported in the literature.

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“…This is in contrast to published findings from a study that randomized 32 patients with heart failure and NYHA Classes III to IV to optimized medical therapy and atrial fibrillation to RVOT or right ventricular apex pacing at one month. 8 The pacing site was switched three months later. About 67% of them responded to cardiac resynchronization therapy, but there was no significant difference between switching of the pacing sites.…”

Section: Discussionmentioning

confidence: 99%

The Importance of Right Ventricular Lead Positioning in Determining Outcomes of Cardiac Resynchronization Therapy

Wong

Watts

et al. 2017

JICRM

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ABSTRACT. Cardiac resynchronization therapy is known to improve clinical outcomes in patients with heart failure and left ventricular dyssynchrony. However, the optimal positioning of the right ventricular lead is unknown, and there is conflicting data on the acute hemodynamic effects and long-term outcomes. Here, we present a case of a patient who underwent implantation of a dual-chamber pacemaker for complete heart block, but who after three months, still had symptoms consistent with New York Heart Association (NYHA) Class IV heart failure. After optimal medical therapy failed and a left ventricular lead was placed, he still remained symptomatic, so the right ventricular lead was repositioned from the right ventricular outflow tract to the right ventricular apex. Afterwards, the patient's symptoms improved from NYHA Class IV to NYHA Class II, and his left ventricular ejection fraction improved from 20% to 45%.

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Right ventricular lead positioning does not influence the benefits of cardiac resynchronization therapy in patients with heart failure and atrial fibrillation

Abstract: In this randomized controlled study, the exact RV pacing site, either apex or outflow tract, did not influence the benefits of CRT in a group of patients with chronic heart failure and AF. ClinicalTrials.gov ID: NCT00457834.

Cited by 12 publications

References 24 publications

Clinical and echocardiographic response of apical vs nonapical right ventricular lead position in CRT: A meta‐analysis

Clinical and echocardiographic response of apical vs nonapical right ventricular lead position in CRT: A meta‐analysis

Focus on right ventricular outflow tract septal pacing

The Importance of Right Ventricular Lead Positioning in Determining Outcomes of Cardiac Resynchronization Therapy

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