Key result
Epicardial LV leads linked to ~73% fewer long-term failures vs transvenous leads.
Why the study?
The study aimed to evaluate the technical performance of epicardial LV leads placed via video-assisted thoracic surgery compared to transvenously placed leads for CRT.
Does epicardial left ventricular lead placement via VATS reduce lead failure compared to transvenous placement in patients undergoing CRT?
Cohort (n=644)
Does epicardial left ventricular lead placement via VATS reduce lead failure compared to transvenous placement in patients undergoing CRT?
Absolute Event Rate: 3% vs 11%
p-value: p=0.037
Epicardial LV leads placed via VATS demonstrate significantly lower long-term failure rates compared to transvenous leads, supporting their use when transvenous placement fails or in challenging cases.
May support epicardial leads when transvenous fails; leaves open randomized confirmation in CRT.
Aims: to study the technical performance of epicardial left ventricular (LV) leads placed via video assisted thoracic surgery (VATS), compared to transvenously placed leads for cardiac resynchronization therapy (CRT). Methods: From 2001 until 2013, a total of 644 lead placement procedures were performed for CRT. In the case of unsuccessful transvenous LV lead placement, the patient received an epicardial LV lead. Study groups consist of 578 patients with a transvenous LV lead and 66 with an epicardial LV lead. The primary endpoint was LV-lead failure necessitating a replacement or deactivation. The secondary endpoint was energy consumption. Results: The mean follow up was 5.9 years (epicardial: 5.5 ± 3.1, transvenous: 5.9 ± 3.5). Transvenous leads failed significantly more frequently than epicardial leads with a total of 66 (11%) in the transvenous leads group vs. 2 (3%) in the epicardial lead group (p = 0.037). Lead energy consumption was not significantly different between groups. Conclusions: Epicardial lead placement is feasible, safe and shows excellent long-term performance compared to transvenous leads. Epicardial lead placement should be considered when primary transvenous lead placement fails or as a primary lead placement strategy in challenging cases.
No takes yet. Share an insight, caveat, or question.
Maat et al. (2023) conducted a cohort in Patients requiring cardiac resynchronization therapy (CRT) (n=644). Epicardial left ventricular (LV) lead placement via VATS vs. Transvenous LV lead placement was evaluated on LV-lead failure necessitating a replacement or deactivation (p=0.037). Epicardial left ventricular leads had significantly lower long-term failure rates compared to transvenous leads (3% vs 11%, p=0.037) over a mean follow-up of 5.9 years.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: