May 13, 2022Heart Rhythm O2Open Access

Targeting the latest site of left ventricular mechanical activation is associated with improved long-term outcomes for recipients of cardiac resynchronization therapy

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Cardiac resynchronization therapy recipients (n=289). Intervention: Imaging-guided LV lead placement in the latest activated scar-free segment vs. Standard of care. Primary outcome: Combined endpoint (mortality and heart failure hospitalization) (p=0.057).

Q: What does this research mean for the field?

Imaging-guided left ventricular lead placement targeting the latest activated segment reduces long-term heart failure hospitalization in patients receiving cardiac resynchronization therapy. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Imaging-guided LV lead placement in the latest activated segment cuts HF hospitalizations ~29% versus standard care.

P=0.057
n=289

Why the study?

Previous studies suggested that targeting the site of latest mechanical activation of the left ventricle improves CRT outcomes, but whether these benefits are sustained over medium-term follow-up was unknown.

Does imaging-guided left ventricular lead placement in the latest activated scar-free segment reduce mortality and heart failure hospitalization in patients receiving cardiac resynchronization therapy?

Population

289 patients across 2 randomized controlled trials

Comparison

Imaging-guided LV lead placement in the latest activated scar-free segment vs standard of care

Design

Patient-level meta-analysis of 2 randomized controlled trials

Follow-up

Median of 6.3 years

Authors

RBRasmus BorgquistElectrophysiology WBWilliam R. BarringtonUniversity of Pittsburgh Medical Center ZBZ. BakosUniversity of Veterinary Medicine

Discussion

Member takes

Implication

Imaging-guided LV lead placement targeting latest activation reduces medium-term HF hospitalization in CRT; extends short-term RCT benefits to 6-year follow-up.

Study Design

Type

Meta-Analysis (n=289)

Multicenter

Yes

Structured PICO

Population

289 patients receiving cardiac resynchronization therapy followed for a median of 6.3 years.

Intervention

Imaging-guided left ventricular lead placement in the latest activated scar-free segment

Comparator

Standard of care left ventricular lead placement

Outcome

Combined endpoint of mortality and heart failure hospitalization at median 6.3 years follow-upcomposite

Main Result

Absolute Event Rate: 47% vs 59%

p-value: p=0.057

Imaging-guided LV lead placement targeting the latest activated scar-free segment in CRT patients reduces long-term heart failure hospitalizations compared to standard of care.

Cite This Study

Borgquist et al. (2022) conducted a meta-analysis in Cardiac resynchronization therapy recipients (n=289). Imaging-guided LV lead placement in the latest activated scar-free segment vs. Standard of care was evaluated on Combined endpoint (mortality and heart failure hospitalization) (p=0.057). Imaging-guided left ventricular lead placement in the latest activated segment reduced heart failure hospitalization compared to standard care (30% vs 42%; P=0.035) over a median 6.3 years.

synapsesocial.com/papers/6aa92c676dc8754dbe62e295 https://doi.org/10.1016/j.hroo.2022.05.003

Topics

Heart failure HFrEF treatment

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Implication

Imaging-guided LV lead placement targeting latest activation reduces medium-term HF hospitalization in CRT; extends short-term RCT benefits to 6-year follow-up.

Targeting the latest site of left ventricular mechanical activation is associated with improved long-term outcomes for recipients of cardiac resynchronization therapy

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Targeting the latest site of left ventricular mechanical activation is associated with improved long-term outcomes for recipients of cardiac resynchronization therapy

Discussion

Member takes

Implication

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

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