Key result
Targeted LV lead positioning fails to reduce mortality or HF hospitalization vs. routine placement.
Why the study?
Several studies evaluated electrically- or imaging-guided LV lead placement in CRT recipients, prompting an assessment of evidence for targeting the site of latest LV activation.
Does targeted left ventricular lead positioning improve clinical outcomes or reduce heart failure hospitalizations and mortality compared to routine placement in patients receiving cardiac resynchronization therapy?
Meta-Analysis (n=1,323)
Does targeted left ventricular lead positioning improve clinical outcomes or reduce heart failure hospitalizations and mortality compared to routine placement in patients receiving cardiac resynchronization therapy?
Targeting the left ventricular lead to the site of latest activation does not provide significant clinical benefit over routine placement in cardiac resynchronization therapy.
Answers are grounded in this paper and cite their sources.
Targeted LV lead positioning confers no CRT outcome benefit; challenges guided strategies and supports routine placement as standard.
AIMS: Several studies have evaluated the use of electrically- or imaging-guided left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) recipients. We aimed to assess evidence for a guided strategy that targets LV lead position to the site of latest LV activation. METHODS AND RESULTS: A systematic review and meta-analysis was performed for randomized controlled trials (RCTs) until March 2023 that evaluated electrically- or imaging-guided LV lead positioning on clinical and echocardiographic outcomes. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization, and secondary endpoints were quality of life, 6-min walk test (6MWT), QRS duration, LV end-systolic volume, and LV ejection fraction. We included eight RCTs that comprised 1323 patients. Six RCTs compared guided strategy (n = 638) to routine (n = 468), and two RCTs compared different guiding strategies head-to-head: electrically- (n = 111) vs. imaging-guided (n = 106). Compared to routine, a guided strategy did not significantly reduce the risk of the primary endpoint after 12-24 (RR 0.83, 95% CI 0.52-1.33) months. A guided strategy was associated with slight improvement in 6MWT distance after 6 months of follow-up of absolute 18 (95% CI 6-30) m between groups, but not in remaining secondary endpoints. None of the secondary endpoints differed between the guided strategies. CONCLUSION: In this study, a CRT implantation strategy that targets the latest LV activation did not improve survival or reduce heart failure hospitalizations.
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Fyenbo et al. (2023) conducted a meta-analysis in Heart failure requiring cardiac resynchronization therapy (n=1,323). Targeted left ventricular lead positioning (imaging- or electrically-guided) vs. Routine left ventricular lead placement was evaluated on Composite of all-cause mortality and heart failure hospitalization (RR 0.83, 95% CI 0.52-1.33). Targeted left ventricular lead positioning did not significantly reduce the risk of the primary composite endpoint of all-cause mortality and heart failure hospitalization compared to routine positioning.
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