Fatima Ali-Ahmed1, Frederik Dalgaard2, Nancy M Allen Lapointe3, Andrzej S Kosinski4, Vanessa Blumer5, Daniel P Morin6, Gillian D Sanders7, Sana M Al-Khatib5. 1. Department of Cardiology, Mayo Clinic, Rochester, MN 55902, United States of America. Electronic address: Ali-Ahmed.Fatima@mayo.edu. 2. Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark. 3. Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States of America; Duke-Margolis Center for Health Policy, Durham, NC 27710, United States of America; Duke University, Durham, NC 27710, United States of America. 4. Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, United States of America. 5. Division of Cardiology, Duke University Medical Center, Durham, NC 27710, United States of America; Duke Clinical Research Institute, Durham, NC 27710, United States of America. 6. Department of Cardiology, Ochsner Medical Center, New Orleans, LA 70121, United States of America. 7. Duke-Margolis Center for Health Policy, Durham, NC 27710, United States of America; Duke Clinical Research Institute, Durham, NC 27710, United States of America; Department of Population Health Sciences, Durham, NC 27710, United States of America.
Abstract
BACKGROUND: Cardiac resynchronization therapy (CRT) has been demonstrated to improve heart failure (HF) symptoms, reverse LV remodeling, and reduce mortality and HF hospitalization (HFH) in patients with a reduced left ventricular (LV) ejection fraction (LVEF). Prior studies examining outcomes based on right ventricular (RV) lead position among CRT patients have provided mixed results. We performed a systematic review and meta-analysis of randomized controlled trials and prospective observational studies comparing RV apical (RVA) and non-apical (RVNA) lead position in CRT. METHODS: Our meta-analysis was constructed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses. We searched EMBASE and MEDLINE. Eligible studies reported on at least one of the following outcomes of interest: all-cause mortality, the composite endpoint of death and first HFH hospitalization, change in LVEF, New York Heart Association (NYHA) class improvement, and change in LV end systolic volume (LVESV). We performed meta-analysis summaries using a DerSimonian-Laird random-effects model and conservatively used the Knapp-Hartung approach to adjust the standard errors of the estimated model coefficients. RESULTS: We included nine studies representing a total of 1832 patients. Of those, 1318 (72%) patients had RVA lead placement and 514 (28%) had RVNA lead placement. The mean age of patients was 65.5 ± 4.4 years, and they were predominantly men (69%-97%). There was no statistically significant difference in all-cause mortality by RVA vs. RVNA (OR = 0.77, 95% CI 0.32-1.89; I2 = 16.7%, p = 0.31), or in the combined endpoint of all-cause mortality and first HFH (OR 0.88, 95% CI 0.62-1.25; I2 = 0%, p = 0.84). Also, there was no difference between RVA and RVNA for NYHA class improvement (OR = 1.03, 95% CI 0.9-1.17; I2 = 0%, p = 0.99), change in LVEF (mean difference (MD) = 1.33, 95% CI -1.45 to 4.10; I2 = 47%; p = 0.093), and change in LVESV (MD = -1.11, 95% CI -3.34 to 1.12; I2 = 0%; p = 0.92). CONCLUSION: This meta-analysis shows that in CRT pacing, RV lead position does not appear to be associated with clinical outcomes or LV reverse remodeling. Further studies should focus on the relationship of RV lead vis-à-vis LV lead location, and its clinical importance.
BACKGROUND: Cardiac resynchronization therapy (CRT) has been demonstrated to improve heart failure (HF) symptoms, reverse LV remodeling, and reduce mortality and HF hospitalization (HFH) in patients with a reduced left ventricular (LV) ejection fraction (LVEF). Prior studies examining outcomes based on right ventricular (RV) lead position among CRT patients have provided mixed results. We performed a systematic review and meta-analysis of randomized controlled trials and prospective observational studies comparing RV apical (RVA) and non-apical (RVNA) lead position in CRT. METHODS: Our meta-analysis was constructed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses. We searched EMBASE and MEDLINE. Eligible studies reported on at least one of the following outcomes of interest: all-cause mortality, the composite endpoint of death and first HFH hospitalization, change in LVEF, New York Heart Association (NYHA) class improvement, and change in LV end systolic volume (LVESV). We performed meta-analysis summaries using a DerSimonian-Laird random-effects model and conservatively used the Knapp-Hartung approach to adjust the standard errors of the estimated model coefficients. RESULTS: We included nine studies representing a total of 1832 patients. Of those, 1318 (72%) patients had RVA lead placement and 514 (28%) had RVNA lead placement. The mean age of patients was 65.5 ± 4.4 years, and they were predominantly men (69%-97%). There was no statistically significant difference in all-cause mortality by RVA vs. RVNA (OR = 0.77, 95% CI 0.32-1.89; I2 = 16.7%, p = 0.31), or in the combined endpoint of all-cause mortality and first HFH (OR 0.88, 95% CI 0.62-1.25; I2 = 0%, p = 0.84). Also, there was no difference between RVA and RVNA for NYHA class improvement (OR = 1.03, 95% CI 0.9-1.17; I2 = 0%, p = 0.99), change in LVEF (mean difference (MD) = 1.33, 95% CI -1.45 to 4.10; I2 = 47%; p = 0.093), and change in LVESV (MD = -1.11, 95% CI -3.34 to 1.12; I2 = 0%; p = 0.92). CONCLUSION: This meta-analysis shows that in CRT pacing, RV lead position does not appear to be associated with clinical outcomes or LV reverse remodeling. Further studies should focus on the relationship of RV lead vis-à-vis LV lead location, and its clinical importance.
Authors: Michele Brignole; Angelo Auricchio; Gonzalo Baron-Esquivias; Pierre Bordachar; Giuseppe Boriani; Ole-A Breithardt; John Cleland; Jean-Claude Deharo; Victoria Delgado; Perry M Elliott; Bulent Gorenek; Carsten W Israel; Christophe Leclercq; Cecilia Linde; Lluís Mont; Luigi Padeletti; Richard Sutton; Panos E Vardas; Jose Luis Zamorano; Stephan Achenbach; Helmut Baumgartner; Jeroen J Bax; Héctor Bueno; Veronica Dean; Christi Deaton; Cetin Erol; Robert Fagard; Roberto Ferrari; David Hasdai; Arno W Hoes; Paulus Kirchhof; Juhani Knuuti; Philippe Kolh; Patrizio Lancellotti; Ales Linhart; Petros Nihoyannopoulos; Massimo F Piepoli; Piotr Ponikowski; Per Anton Sirnes; Juan Luis Tamargo; Michal Tendera; Adam Torbicki; William Wijns; Stephan Windecker; Paulus Kirchhof; Carina Blomstrom-Lundqvist; Luigi P Badano; Farid Aliyev; Dietmar Bänsch; Helmut Baumgartner; Walid Bsata; Peter Buser; Philippe Charron; Jean-Claude Daubert; Dan Dobreanu; Svein Faerestrand; David Hasdai; Arno W Hoes; Jean-Yves Le Heuzey; Hercules Mavrakis; Theresa McDonagh; Jose Luis Merino; Mostapha M Nawar; Jens Cosedis Nielsen; Burkert Pieske; Lidija Poposka; Frank Ruschitzka; Michal Tendera; Isabelle C Van Gelder; Carol M Wilson Journal: Eur Heart J Date: 2013-06-24 Impact factor: 29.983
Authors: Jagmeet P Singh; Helmut U Klein; David T Huang; Sven Reek; Malte Kuniss; Aurelio Quesada; Alon Barsheshet; David Cannom; Ilan Goldenberg; Scott McNitt; James P Daubert; Wojciech Zareba; Arthur J Moss Journal: Circulation Date: 2011-03-07 Impact factor: 29.690
Authors: Usama A Daimee; Helmut U Klein; Michael C Giudici; Wojciech Zareba; Scott McNitt; Bronislava Polonsky; Arthur J Moss; Valentina Kutyifa Journal: J Interv Card Electrophysiol Date: 2018-03-23 Impact factor: 1.900
Authors: E Kevin Heist; Dali Fan; Theofanie Mela; Daniel Arzola-Castaner; Vivek Y Reddy; Moussa Mansour; Michael H Picard; Jeremy N Ruskin; Jagmeet P Singh Journal: Am J Cardiol Date: 2005-09-01 Impact factor: 2.778
Authors: Gabe B Bleeker; Sjoerd A Mollema; Eduard R Holman; Nico Van de Veire; Claudia Ypenburg; Eric Boersma; Ernst E van der Wall; Martin J Schalij; Jeroen J Bax Journal: Circulation Date: 2007-09-04 Impact factor: 29.690
Authors: Marat Fudim; Frederik Dalgaard; Sana M Al-Khatib; Daniel J Friedman; Kathryn Lallinger; William T Abraham; John G F Cleland; Anne B Curtis; Michael R Gold; Valentina Kutyifa; Cecilia Linde; Daniel E Schaber; Anthony Tang; Fatima Ali-Ahmed; Sarah A Goldstein; Brystana Kaufman; Robyn Fortman; J Kelly Davis; Lurdes Y T Inoue; Gillian D Sanders Journal: Am Heart J Date: 2020-02-21 Impact factor: 4.749