WiSE CRT Is Beneficial for Heart Failure Patients as a Rescue Therapy: Evidence From a Meta-Analysis
Jiehui Cang1, Yaowu Liu1, Didi Zhu1
1Department of Cardiology, Zhongda Hospital of Southeast University, Nanjing, China.
Insights
Leadless endocardial left ventricular pacing offers a novel solution for heart failure patients who did not benefit from conventional cardiac resynchronization therapy. This innovative approach shows significant improvements in key cardiac metrics.
Area of Science:
- Cardiology
- Medical Devices
- Heart Failure Management
Background:
- Conventional cardiac resynchronization therapy (CRT) is ineffective for some heart failure (HF) patients.
- Leadless endocardial pacing presents a novel alternative for these challenging cases.
Approach:
- A systematic review and meta-analysis of cohort studies was conducted.
- Data from five studies involving 175 HF patients receiving WiSE CRT were analyzed.
- Key clinical outcomes including ejection fraction (EF), QRS duration (QRSd), and ventricular volumes were assessed.
Key Points:
- WiSE CRT demonstrated a high implantation success rate (76.5-100%).
- Significant improvements were observed in QRSd narrowing, EF enhancement, and reduction in LVESV and LVEDV.
- Mean QRSd reduction was -38.21 ms, EF improved by 6.07%, and LVESV decreased by -23.47 ml.
Conclusions:
- Leadless endocardial LV pacing is effective for HF patients with failed conventional CRT.
- This therapy may serve as a valuable rescue option or for device upgrades.
- Further research supports its role in advanced heart failure management.
Background:
Leadless endocardial left ventricular (LV) pacing resynchronization therapy is a novel solution for patients with heart failure (HF) in whom conventional cardiac resynchronization therapy (CRT) failed.
Methods:
PubMed and the Cochrane Library were searched for relevant cohort studies. Clinical outcomes of interest such as ejection fraction (EF), QRS duration (QRSd), and left ventricular end-systolic volume (LVESV) were extracted and analyzed.
Results:
Five studies involving 175 HF patients for WiSE CRT were included, and patients were followed-up for 6 months. The implanted success rate ranged from 76.5 to 100%. WiSE CRT resulted in significantly narrower QRSd [mean difference (MD): -38.21 ms, 95% confidence interval (CI): -44.36 to -32.07, p < 0.001], improved left ventricular ejection fraction (MD: 6.07%, 95% CI: 4.43 to 7.71, I2 = 0%, p < 0.001), reduced left ventricular end-systolic volume (MD: -23.47 ml, 95% CI: -37.18 to -9.13, p < 0.001), and reduced left ventricular end-diastolic volume (MD: -24.02 ml, 95% CI: -37.01 to -11.03, p = 0.02).
Conclusion:
Evidence from current studies suggests that leadless endocardial LV pacing resynchronization is effective for HF patients who failed conventional CRT or needed a device upgrade, and it may be an interesting rescue therapy.
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