Key result
Septal right ventricle defibrillator lead placement showed no difference in mortality compared to apical placement, but improved pacing threshold (P=0.003) and HF readmissions (P=0.02).
Why the study?
Published data comparing the efficacy and safety of apical versus septal right ventricular defibrillator lead positioning required review.
Does septal right ventricular defibrillator lead placement improve efficacy and safety outcomes compared to apical placement in patients receiving ICD or CRT devices?
Meta-Analysis (n=1,438)
Does septal right ventricular defibrillator lead placement improve efficacy and safety outcomes compared to apical placement in patients receiving ICD or CRT devices?
Septal right ventricular defibrillator lead placement offers modest benefits in pacing threshold, shock impedance, and heart failure readmissions compared to apical placement, but does not significantly affect mortality, suggesting placement site is not of major overall importance.
Supports septal RV lead placement to optimize thresholds and reduce HF readmissions; extends pooled evidence for flexible positioning in ICD/CRT.
This study reviews the published data comparing the efficacy and safety of apical and septal right ventricle defibrillator lead positioning at 1-year follow-up. Systemic research on Medline (PubMed), ClinicalTrials.gov , and Embase was performed using the keywords "septal defibrillation," "apical defibrillation," "site defibrillation," and "defibrillation lead placement," including implantable cardioverter-defibrillator and cardiac resynchronization therapy devices. Comparisons between apical and septal position were performed regarding R-wave amplitude, pacing threshold at a pulse width of 0.5 ms, pacing and shock lead impedance, suboptimal lead performance, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter, readmissions due to heart failure and mortality rates. A total of 5 studies comprising 1438 patients were included in the analysis. Mean age was 64.5 years, 76.9% were male, with a median LVEF of 27.8%, ischemic etiology in 51.1%, and a mean follow-up period of 26.5 months. The apical lead placement was performed in 743 patients and septal lead placement in 690 patients. Comparing the 2 placement sites, no significant differences were found regarding R-wave amplitude, lead impedance, suboptimal lead performance, LVEF, left ventricular end-diastolic diameter, and mortality rate at 1-year follow-up. Pacing threshold values favored septal defibrillator lead placement ( P = 0.003), as well as shock impedance ( P = 0.009) and readmissions due to heart failure ( P = 0.02). Among patients receiving a defibrillator lead, only pacing threshold, shock lead impedance, and readmission due to heart failure showed results favoring septal lead placement. Therefore, generally, the right ventricle lead placement does not appear to be of major importance.
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Santos et al. (2023) conducted a meta-analysis in Patients receiving defibrillation leads (n=1,438). Septal right ventricle defibrillator lead positioning vs. Apical right ventricle defibrillator lead positioning was evaluated on Efficacy and safety including mortality, heart failure readmissions, and lead performance metrics. Septal right ventricle defibrillator lead placement showed no difference in mortality compared to apical placement, but improved pacing threshold (P=0.003) and HF readmissions (P=0.02).
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