Endocardial left ventricular pacing for cardiac resynchronization: systematic review and meta-analysis

Area of Science:

• Cardiology
• Medical Devices
• Electrophysiology

Background:

• Conventional Cardiac Resynchronization Therapy (CRT) involves left ventricular (LV) lead placement via the coronary sinus.
• Endocardial LV pacing presents an alternative strategy for CRT delivery.
• Assessing the efficacy and safety of endocardial LV pacing is crucial for patient selection.

Purpose of the Study:

• To conduct a meta-analysis evaluating the benefits and risks of endocardial LV pacing compared to conventional CRT.
• To determine the clinical response rates and complication profiles associated with endocardial LV pacing.

Main Methods:

• Systematic literature search of online databases for studies on lead-based endocardial pacing.
• Random-effects meta-analysis to assess procedural success, clinical response (≥1 NYHA class decrease), and complication rates.
• Inclusion of 23 studies with 384 patients, analyzing various endocardial pacing techniques (trans-atrial septal, trans-ventricular apical, trans-ventricular septal).

Main Results:

• Procedural success rates exceeded 95% across all included studies.
• An overall clinical response estimate of 82% (95% CI 71-89%) was observed, with significant heterogeneity noted.
• Thromboembolic complications included stroke at 2.5 events/100 patient-years and TIA at 2.6 events/100 patient-years; mortality rate was 4.5 events/100 patient-years.

Conclusions:

• Endocardial LV pacing is a feasible option, particularly when conventional lead placement is challenging.
• Clinical response rates are comparable to conventional CRT, despite observed heterogeneity.
• A slight increase in stroke risk may be associated with endocardial pacing, especially in high-risk patient populations.