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Outcomes of Cardiac Resynchronization Therapy with Image-Guided Left Ventricular Lead Placement at the Site of Latest Mechanical Activation: A Systematic Review and Meta-Analysis.

Publication ,  Journal Article
Allen LaPointe, NM; Ali-Ahmed, F; Dalgaard, F; Kosinski, AS; Schmidler, GS; Al-Khatib, SM
Published in: J Interv Cardiol
2022

AIM: To assess evidence for an image-guided approach for cardiac resynchronization therapy (CRT) that targets left ventricular (LV) lead placement at the segment of latest mechanical activation. METHODS: A systematic review of EMBASE and PubMed was performed for randomized controlled trials (RCTs) and prospective observational studies from October 2008 through October 2020 that compared an image-guided CRT approach with a non-image-guided approach for LV lead placement. Meta-analyses were performed to assess the association between the image-guided approach and NYHA class improvement or changes in end-systolic volume (LVESV), end-diastolic volume (LVEDV), and ejection fraction (LVEF). RESULTS: From 5897 citations, 5 RCTs including 818 patients (426 image-guided and 392 non-image-guided) were identified. The mean age ranged from 66 to 71 years, 76% were male, and 53% had ischemic cardiomyopathy. Speckle tracking echocardiography was the primary image-guided method in all studies. LV lead placement within the segment of the latest mechanical activation (concordant) was achieved in the image-guided arm in 45% of the evaluable patients. There was a statistically significant improvement in the NYHA class at 6 months (odds ratio 1.66; 95% confidence interval (CI) [1.02, 2.69]) with the image-guided approach, but no statistically significant change in LVESV (MD -7.1%; 95% CI [-16.0, 1.8]), LVEDV (MD -5.2%; 95% CI [-15.8, 5.4]), or LVEF (MD 0.68; 95% CI [-4.36, 5.73]) versus the non-image-guided approach. CONCLUSION: The image-guided CRT approach was associated with improvement in the NYHA class but not echocardiographic measures, possibly due to the small sample size and a low rate of concordant LV lead placement despite using the image-guided approach. Therefore, our meta-analysis was not able to identify consistent improvement in CRT outcomes with an image-guided approach.

Duke Scholars

Published In

J Interv Cardiol

DOI

EISSN

1540-8183

Publication Date

2022

Volume

2022

Start / End Page

6285894

Location

United States

Related Subject Headings

  • Stroke Volume
  • Observational Studies as Topic
  • Myocardial Ischemia
  • Male
  • Humans
  • Heart Ventricles
  • Female
  • Echocardiography
  • Cardiovascular System & Hematology
  • Cardiac Resynchronization Therapy
 

Citation

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ICMJE
MLA
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Allen LaPointe, N. M., Ali-Ahmed, F., Dalgaard, F., Kosinski, A. S., Schmidler, G. S., & Al-Khatib, S. M. (2022). Outcomes of Cardiac Resynchronization Therapy with Image-Guided Left Ventricular Lead Placement at the Site of Latest Mechanical Activation: A Systematic Review and Meta-Analysis. J Interv Cardiol, 2022, 6285894. https://doi.org/10.1155/2022/6285894
Allen LaPointe, Nancy M., Fatima Ali-Ahmed, Frederik Dalgaard, Andrzej S. Kosinski, Gillian Sanders Schmidler, and Sana M. Al-Khatib. “Outcomes of Cardiac Resynchronization Therapy with Image-Guided Left Ventricular Lead Placement at the Site of Latest Mechanical Activation: A Systematic Review and Meta-Analysis.J Interv Cardiol 2022 (2022): 6285894. https://doi.org/10.1155/2022/6285894.
Allen LaPointe NM, Ali-Ahmed F, Dalgaard F, Kosinski AS, Schmidler GS, Al-Khatib SM. Outcomes of Cardiac Resynchronization Therapy with Image-Guided Left Ventricular Lead Placement at the Site of Latest Mechanical Activation: A Systematic Review and Meta-Analysis. J Interv Cardiol. 2022;2022:6285894.
Allen LaPointe, Nancy M., et al. “Outcomes of Cardiac Resynchronization Therapy with Image-Guided Left Ventricular Lead Placement at the Site of Latest Mechanical Activation: A Systematic Review and Meta-Analysis.J Interv Cardiol, vol. 2022, 2022, p. 6285894. Pubmed, doi:10.1155/2022/6285894.
Allen LaPointe NM, Ali-Ahmed F, Dalgaard F, Kosinski AS, Schmidler GS, Al-Khatib SM. Outcomes of Cardiac Resynchronization Therapy with Image-Guided Left Ventricular Lead Placement at the Site of Latest Mechanical Activation: A Systematic Review and Meta-Analysis. J Interv Cardiol. 2022;2022:6285894.
Journal cover image

Published In

J Interv Cardiol

DOI

EISSN

1540-8183

Publication Date

2022

Volume

2022

Start / End Page

6285894

Location

United States

Related Subject Headings

  • Stroke Volume
  • Observational Studies as Topic
  • Myocardial Ischemia
  • Male
  • Humans
  • Heart Ventricles
  • Female
  • Echocardiography
  • Cardiovascular System & Hematology
  • Cardiac Resynchronization Therapy