Key result
Epicardial LV electrodes match endocardial stimulation but are linked to ~15% higher absolute mortality.
Why the study?
Does epicardial left ventricular lead implantation provide similar electrical performance, clinical response, and safety compared to transvenous implantation in patients receiving CRT?
Case-Control (n=184)
Yes
Does epicardial left ventricular lead implantation provide similar electrical performance, clinical response, and safety compared to transvenous implantation in patients receiving CRT?
Absolute Event Rate: 98.1% vs 96.6%
p-value: p=0.62
While epicardial LV leads provide effective resynchronization comparable to transvenous leads, they require higher pacing energy and are associated with higher mortality, likely reflecting a sicker patient population requiring surgical intervention.
Supports caution with epicardial LV leads in CRT; leaves open whether higher mortality reflects selection bias or true risk.
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Fedorco et al. (2017) conducted a case-control in Heart failure indicated for cardiac resynchronization therapy (n=184). Epicardial left ventricular electrode implantation vs. Endovascular (transvenous) left ventricular electrode implantation was evaluated on Effective left ventricular stimulation at 3-year follow-up (p=0.62). Epicardial left ventricular electrodes provided effective stimulation comparable to endocardial electrodes at 3 years (98.1% vs 96.6%), but were associated with significantly higher 3-year mortality (21.7% vs 6.5%).
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