Apical vs. non-apical right ventricular pacing in cardiac resynchronization therapy: a meta-analysis
Theodoros A Zografos1, Konstantinos C Siontis2, Marek Jastrzebski3
1Department of Cardiology, Athens Euroclinic, 9 Athanasiadou Str., 115 21 Athens, Greece.
Summary
Right ventricular apical (RVA) versus non-apical (RVNA) pacing in cardiac resynchronization therapy (CRT) shows similar effects on left ventricular remodeling and functional status. Further trials are needed to assess mortality and morbidity outcomes.
Area of Science:
- Cardiology
- Electrophysiology
- Heart Failure Management
Background:
- Cardiac resynchronization therapy (CRT) improves outcomes in heart failure patients.
- The optimal right ventricular (RV) lead placement for CRT remains undetermined.
- Comparing RV apical (RVA) and non-apical (RVNA) pacing is crucial for optimizing CRT.
Purpose of the Study:
- To compare the mid- and long-term effects of RVA versus RVNA pacing on CRT outcomes.
- To analyze left ventricular end-systolic volume (LVESV) reduction and functional status improvement.
- To evaluate the impact on mortality and cardiovascular hospitalizations.
Main Methods:
- Meta-analysis of randomized-controlled trials and observational studies.
- Systematic search of Cochrane library, EMBASE, and MEDLINE databases.
- Pooled effect estimates using random-effect models for LVESV reduction and functional status.
Main Results:
- Twelve studies with 2670 patients were included.
- No significant difference in LVESV reduction between RVA and RVNA pacing (SMD 0.13, P=0.48).
- Similar functional status improvement (≥1 NYHA class) for both pacing groups (OR 1.08, P=0.60).
Conclusions:
- RVA and RVNA pacing yield similar outcomes regarding LV remodeling and functional status in CRT patients.
- Data on mortality and hospitalizations were insufficient for pooling due to heterogeneity.
- Randomized clinical trials are necessary to further investigate mortality and morbidity with different RV lead positions.
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