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March 31, 2015EP EuropaceOpen Access

Apical vs. non-apical right ventricular pacing in cardiac resynchronization therapy: a meta-analysis

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Why the study?

Does right ventricular non-apical pacing improve LV remodeling, functional status, or clinical outcomes compared to apical pacing in heart failure patients receiving CRT?

Population

2670 patients with heart failure receiving cardiac resynchronization therapy from 12 studies

Comparison

Right ventricular non-apical (RVNA) pacing vs Right ventricular apical (RVA) pacing

Design

Meta-analysis

Follow-up

mid- and long-term

Key result

Right ventricular apical pacing and non-apical pacing in CRT patients resulted in similar left ventricular end-systolic volume reduction (SMD 0.13; 95% CI -0.24 to 0.50; P=0.48).

Authors

TZTheodoros ZografosKSKonstantinos C. SiontisMJMarek Jastrzębski

Discussion

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Overview

Either RV pacing site suffices for LV remodeling in CRT; confirms no advantage for non-apical placement but leaves mortality data open due to heterogeneity.

Key Points

  • This meta-analysis aims to compare the effects of apical and non-apical pacing in cardiac resynchronization therapy on patient outcomes.
  • Conducted a meta-analysis of randomized-controlled trials and observational studies.
  • Included 12 studies with 2670 patients evaluating RVA versus RVNA pacing.
  • Analyzed left ventricular end-systolic volume reduction and functional status improvement using standardized mean difference and odds ratio.
  • In patients with RVA and RVNA pacing, LVESV reduction was similar (SMD 0.13, 95% CI: -0.24 to 0.50, P = 0.48).
  • Functional status improvement was also comparable (OR 1.08, 95% CI: 0.81 to 1.45, P = 0.60).
  • Mortality and hospitalization outcomes could not be pooled due to heterogeneity in studies.

Study Design

Type

Meta-Analysis (n=2,670)

Structured PICO

Does right ventricular non-apical pacing improve LV remodeling, functional status, or clinical outcomes compared to apical pacing in heart failure patients receiving CRT?

P
Population
2670 patients with heart failure receiving cardiac resynchronization therapy (CRT) from 12 studies (randomized-controlled trials and observational studies)
I
Intervention
Right ventricular non-apical (RVNA) pacing
C
Comparator
Right ventricular apical (RVA) pacing
O
Outcome
Left ventricular end-systolic volume (LVESV) reduction, functional status improvement (defined as ≥1 New York Heart Association class improvement), and clinical outcome of mortality or cardiovascular hospitalization

Main Result

Effect estimate: SMD 0.13 (95% CI -0.24 to 0.50)

p-value: p=0.48

In patients receiving cardiac resynchronization therapy, right ventricular apical and non-apical pacing result in similar improvements in left ventricular remodeling and functional status.

Limitations

  • Data regarding mortality and hospitalizations could not be pooled due to a small number of relevant studies with significant heterogeneity.
  • Small number of relevant studies with significant heterogeneity for mortality and hospitalization outcomes

Cite This Study

Zografos et al. (2015) conducted a meta-analysis in Heart failure (n=2,670). Right ventricular apical (RVA) pacing vs. Right ventricular non-apical (RVNA) pacing was evaluated on Left ventricular end-systolic volume (LVESV) reduction (SMD 0.13, 95% CI -0.24 to 0.50, p=0.48). Right ventricular apical pacing and non-apical pacing in CRT patients resulted in similar left ventricular end-systolic volume reduction (SMD 0.13; 95% CI -0.24 to 0.50; P=0.48).

synapsesocial.com/papers/6a15c24737103a4337a02653https://doi.org/10.1093/europace/euv048
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