A systemic review of endocardial left ventricular pacing

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Endocardial left ventricular pacing serves as an alternative for cardiac resynchronization therapy (CRT).
• It is considered when coronary sinus lead placement is not feasible or in cases of non-response to conventional CRT.

Purpose of the Study:

• To systematically review the efficacy and safety of endocardial left ventricular pacing.
• To analyze its impact on clinical, electrocardiographic, and echocardiographic parameters.

Main Methods:

• A systematic literature search was conducted across Medline, ClinicalTrials.gov, and Embase.
• Eleven studies involving 560 patients using various endocardial pacing techniques were included.
• Outcomes assessed included NYHA functional class, LVEF, QRS width, and complication occurrence.

Main Results:

• Significant improvements were observed in NYHA class, left ventricular ejection fraction (LVEF), and QRS width.
• However, the study reported substantial complication rates, including pocket infections, transient ischemic attacks, ischemic strokes, and thromboembolic events.
• The overall mortality rate during follow-up was 20.54%.

Conclusions:

• Endocardial left ventricular pacing is a viable alternative for CRT, demonstrating improvements in patient outcomes.
• Despite its feasibility, the procedure is associated with significant complication rates and mortality.