Systematic review and meta‐analysis of left ventricular endocardial pacing in advanced heart failure: Clinically efficacious but at what cost?

Graham, Aaron; Providenica, Rui; Honarbakhsh, Shohreh; Srinivasan, Neil; Sawhney, Vinit; Hunter, Ross J.; Lambiase, Pier D.

doi:10.1111/pace.13275

Cited by 11 publications

(9 citation statements)

References 41 publications

(239 reference statements)

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“…Most studies demonstrated significant improvements in LV remodeling and favorable clinical response to CRT; however, its procedural complexity and substantial long-term thromboembolic risk limit wider adoption. [16][17][18][19] The ALSYNC (Alternate Site Cardiac Resynchronization) was the first multicenter trial of LV endocardial transvenous lead pacing (superior transvenous atrial transseptal approach), which enrolled 138 patients who either had a failed transvenous CS lead or had nonresponse to CRT. 20 The procedure was successful in 118 of the 132 attempted cases (89%).…”

Section: Discussionmentioning

confidence: 99%

Leadless left ventricular stimulation with WiSE-CRT System – Initial experience and results from phase I of SOLVE-CRT Study (nonrandomized, roll-in phase)

et al. 2022

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BACKGROUND Left ventricular (LV) endocardial pacing is a promising method to deliver cardiac resynchronization therapy (CRT). WiSE-CRT is a wireless LV endocardial pacing system, and delivers ultrasonic energy to an LV electrode.OBJECTIVE The purpose of this study was to present short-term outcomes with the WiSE-CRT system in centers with no prior implanting experience.METHODS Data were prospectively collected from 19 centers where WiSE-CRT systems were implanted during the roll-in phase of the SOLVE-CRT trial. Patients were followed at 1, 3, and 6 months, including transthoracic echo (TTE) at 6 months. RESULTSThe WiSE-CRT was successfully implanted in all 31 attempted cases, and 30 patients completed the 6-month followup. One patient underwent heart transplantation 1 month after implantation, and was excluded. Fourteen (46.7%) patients demonstrated 1 NYHA class improvement. TTE data were available in 29 patients. LV ejection fraction, LV end-systolic volume, and LV enddiastolic volume improved from 28.3% 6 6.7% to 33.5% 6 6.9% (P , .001), 134.9 6 51.3 mL to 111.1 6 40.3 mL (P 5 .0004), and 185.4 6 58.8 mL to 164.9 6 50.6 mL (P 5 .0017), respectively. There were 3 (9.7%) device-related type 1 complications: 1 insufficient LV pacing, 1 embolization of an unanchored LV electrode, and 1 skin infection.CONCLUSIONS We demonstrated a high success rate of LV endocardial electrode placement in centers with no prior implanting experience. Favorable clinical responses in heart failure symptoms and significant LV reverse remodeling were noted.

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Section: Discussionmentioning

confidence: 99%

Leadless left ventricular stimulation with WiSE-CRT System – Initial experience and results from phase I of SOLVE-CRT Study (nonrandomized, roll-in phase)

et al. 2022

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“…Epicardial LV lead placement of CRT has become a routine procedure to improve symptoms and reduce mortality in selected HF patients . To our knowledge, this was the first study on CHF patients evaluating the effect of endocardial biventricular pacing on various locations of the heart on TDR homogeneity.…”

Section: Discussionmentioning

confidence: 99%

Endocardial biventricular pacing for chronic heart failure patients: Effect on transmural dispersion of repolarization

Yamin

Yuniadi

Alwi

et al. 2019

Journal of Arrhythmia

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Background and Aim Conventional epicardial cardiac resynchronization therapy (CRT) can cause fatal arrhythmia associated with increased transmural dispersion of repolarization (TDR). It is unknown whether endocardial biventricular pacing in various locations will decrease TDR and hence the occurrence of fatal arrhythmia. This study aimed to find out the most effective location of endocardial biventricular pacing resulting in the shortest homogenous TDR. Methods A before‐and‐after study on adult chronic heart failure (CHF) patients undergoing endocardial biventricular pacing in several defined locations. The changes in TDR from baseline were compared among various pacing locations. Results Fourteen subjects were included with age ranged 36‐74 years old, of which 10 were males. Location revealed the highest post biventricular pacing TDR (113.4 (SD 13.8) ms) was the outlet septum of right ventricle in combination with lateral wall of left ventricle (RVOTseptum‐LVlateral) while the lowest one (106.1 (SD 11.6) ms) was of the right ventricular apex and posterolateral left ventricle (RVapex‐LVposterolateral). Two CRT locations resulted in the most homogenous TDR, that is the right ventricular apex ‐ left ventricular lateral wall (RVapex‐LVlateral, mean difference −9.43; 95% CI (−19.72;0.87) ms, P = 0.07) and right ventricular apex ‐ left ventricle posterolateral wall (RVapex‐LVposterolateral, mean difference −6.85; 95% CI (−13.93;0.22) ms, P = 0.056). Conclusion Endocardial biventricular pacing on right ventricular apex and left ventricular lateral/posterolateral walls results in the most homogenous TDR.

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“…The main concern around delivery of lead-based endocardial LV pacing remains the risk of thromboembolic complications and the need for long-term anticoagulation. The overall stroke rate reported in one meta-analysis was 3.3–4.2 per 100 patient years, which is significantly higher than reported rates in equivalent heart failure trial populations [ 27 ]. Other concerns include the risk of impairment of and adhesion to the mitral valve by the transseptal lead and the risk associated with infected leads, as left-sided vegetations can lead to systemic embolic complications, and extraction of endocardial LV leads may be more complicated than right-sided leads.…”

Section: Lead-based Left Ventricular Endocardial Pacingmentioning

confidence: 95%

“…Other evidence for lead-based endocardial LV pacing is largely restricted to small single-center case series, and is summarized in two recent meta-analyses that included 362 and 384 patients, respectively [ 27 , 28 ]. In addition to the transseptal interatrial approach used in the ALSYNC trial, transseptal interventricular and transapical approaches to the LV have also been reported.…”

Section: Lead-based Left Ventricular Endocardial Pacingmentioning

confidence: 99%

“…Other concerns include the risk of impairment of and adhesion to the mitral valve by the transseptal lead and the risk associated with infected leads, as left-sided vegetations can lead to systemic embolic complications, and extraction of endocardial LV leads may be more complicated than right-sided leads. The reported rate of lead infection in one meta-analysis was 3.6% (2 per 100 patient years), which is higher than for conventional CRT [ 27 ]. While there were no complications associated with the two leads that were extracted in the included studies, the risks associated with extraction of leads that have been in situ for extended periods of time are unknown.…”

Section: Lead-based Left Ventricular Endocardial Pacingmentioning

confidence: 99%

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Endocardial left ventricular pacing

Elliott

Mehta

Sidhu

et al. 2021

Herz

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Cardiac resynchronization therapy (CRT) is an effective treatment for dyssynchronous heart failure; however, 30–50% of patients fail to improve after implant. Endocardial left ventricular (LV) pacing is an alternative therapy for patients who do not respond to conventional CRT or in whom placement of a lead via the coronary sinus is not possible. It enables pacing at a wide variety of sites, without restrictions due to coronary sinus anatomy, and there is evidence of superior electrical resynchronization and hemodynamic response compared with conventional epicardial CRT. In this article, we discuss the potential advantages and disadvantages of endocardial LV pacing compared with conventional CRT, review the evidence for the delivery of endocardial LV pacing using both lead-based and leadless systems, and explore possible future directions of this novel technology.

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Systematic review and meta‐analysis of left ventricular endocardial pacing in advanced heart failure: Clinically efficacious but at what cost?

Abstract: LV endocardial lead implantation is a potentially efficacious alternative to CS lead placement, but preliminary data suggest a potentially higher risk of stroke during follow-up when compared to the expected incidence of stroke in similar cohorts of patients.

Cited by 11 publications

References 41 publications

Leadless left ventricular stimulation with WiSE-CRT System – Initial experience and results from phase I of SOLVE-CRT Study (nonrandomized, roll-in phase)

Leadless left ventricular stimulation with WiSE-CRT System – Initial experience and results from phase I of SOLVE-CRT Study (nonrandomized, roll-in phase)

Endocardial biventricular pacing for chronic heart failure patients: Effect on transmural dispersion of repolarization

Endocardial left ventricular pacing

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