Anterior Versus Lateral/Posterolateral Left Ventricular Lead Position in CRT: A Systematic Review and Meta‐Analysis

OBJECTIVE: To evaluate the impact of anterior versus lateral/posterolateral left ventricular (LV) lead positioning on clinical and echocardiographic outcomes in patients undergoing cardiac resynchronization therapy (CRT). METHODS: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Electronic databases, including PubMed, Embase, Web of Science, and Cochrane Library, were searched for studies assessing LV lead position and CRT outcomes. Studies comparing anterior with lateral or posterolateral LV lead placement were included. Data were extracted on mortality, CRT response, and left ventricular ejection fraction (LVEF). Pooled effect estimates were calculated using a random-effects model. RESULTS: A total of six studies were included in the qualitative synthesis, with five studies eligible for quantitative meta-analysis. Lateral or posterolateral LV lead positioning was associated with significantly reduced mortality compared to anterior positioning (pooled HR 0.74, 95% CI 0.63-0.86). CRT response rates were significantly higher with lateral/posterolateral positioning (pooled OR 1.40, 95% CI 1.17-1.67). Additionally, patients with optimal lead placement demonstrated greater improvement in LVEF (mean difference 4.0%, 95% CI 1.84-6.16). Heterogeneity across studies was low. CONCLUSION: Lateral or posterolateral LV lead positioning is associated with improved survival, higher CRT response rates, and enhanced reverse remodeling compared to anterior lead placement. Optimizing LV lead position may enhance clinical outcomes in patients undergoing CRT.