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

Graham, AJ; Providenica, R; Honarbakhsh, S; Srinivasan, N; Sawhney, V; Hunter, R; Lambiase, P; (2018) Systematic review and meta-analysis of left ventricular endocardial pacing in advanced heart failure: Clinically efficacious but at what cost? [Review]. Pacing and Clinical Electrophysiology , 41 (4) pp. 353-361. 10.1111/pace.13275. Green open access

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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.

Type: Article
Title: Systematic review and meta-analysis of left ventricular endocardial pacing in advanced heart failure: Clinically efficacious but at what cost?
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/pace.13275
Publisher version: https://doi.org/10.1111/pace.13275
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: endocardial, LV Lead, resynchronization, stroke
UCL classification: UCL
UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > Institute of Cardiovascular Science > Clinical Science
URI: https://discovery.ucl.ac.uk/id/eprint/10076455
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