PMID- 33864874 OWN - NLM STAT- MEDLINE DCOM- 20210830 LR - 20211214 IS - 1873-1740 (Electronic) IS - 0033-0620 (Print) IS - 0033-0620 (Linking) VI - 66 DP - 2021 May-Jun TI - Right ventricular lead location and outcomes among patients with cardiac resynchronization therapy: A meta-analysis. PG - 53-60 LID - S0033-0620(21)00039-6 [pii] LID - 10.1016/j.pcad.2021.04.002 [doi] AB - BACKGROUND: Cardiac resynchronization therapy (CRT) has been demonstrated to improve heart failure (HF) symptoms, reverse LV remodeling, and reduce mortality and HF hospitalization (HFH) in patients with a reduced left ventricular (LV) ejection fraction (LVEF). Prior studies examining outcomes based on right ventricular (RV) lead position among CRT patients have provided mixed results. We performed a systematic review and meta-analysis of randomized controlled trials and prospective observational studies comparing RV apical (RVA) and non-apical (RVNA) lead position in CRT. METHODS: Our meta-analysis was constructed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews and meta-analyses. We searched EMBASE and MEDLINE. Eligible studies reported on at least one of the following outcomes of interest: all-cause mortality, the composite endpoint of death and first HFH hospitalization, change in LVEF, New York Heart Association (NYHA) class improvement, and change in LV end systolic volume (LVESV). We performed meta-analysis summaries using a DerSimonian-Laird random-effects model and conservatively used the Knapp-Hartung approach to adjust the standard errors of the estimated model coefficients. RESULTS: We included nine studies representing a total of 1832 patients. Of those, 1318 (72%) patients had RVA lead placement and 514 (28%) had RVNA lead placement. The mean age of patients was 65.5 +/- 4.4 years, and they were predominantly men (69%-97%). There was no statistically significant difference in all-cause mortality by RVA vs. RVNA (OR = 0.77, 95% CI 0.32-1.89; I(2) = 16.7%, p = 0.31), or in the combined endpoint of all-cause mortality and first HFH (OR 0.88, 95% CI 0.62-1.25; I(2) = 0%, p = 0.84). Also, there was no difference between RVA and RVNA for NYHA class improvement (OR = 1.03, 95% CI 0.9-1.17; I(2) = 0%, p = 0.99), change in LVEF (mean difference (MD) = 1.33, 95% CI -1.45 to 4.10; I(2) = 47%; p = 0.093), and change in LVESV (MD = -1.11, 95% CI -3.34 to 1.12; I(2) = 0%; p = 0.92). CONCLUSION: This meta-analysis shows that in CRT pacing, RV lead position does not appear to be associated with clinical outcomes or LV reverse remodeling. Further studies should focus on the relationship of RV lead vis-a-vis LV lead location, and its clinical importance. CI - Copyright (c) 2021. Published by Elsevier Inc. FAU - Ali-Ahmed, Fatima AU - Ali-Ahmed F AD - Department of Cardiology, Mayo Clinic, Rochester, MN 55902, United States of America. Electronic address: Ali-Ahmed.Fatima@mayo.edu. FAU - Dalgaard, Frederik AU - Dalgaard F AD - Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark. FAU - Allen Lapointe, Nancy M AU - Allen Lapointe NM AD - Department of Medicine, Duke University School of Medicine, Durham, NC 27710, United States of America; Duke-Margolis Center for Health Policy, Durham, NC 27710, United States of America; Duke University, Durham, NC 27710, United States of America. FAU - Kosinski, Andrzej S AU - Kosinski AS AD - Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC 27710, United States of America. FAU - Blumer, Vanessa AU - Blumer V AD - Division of Cardiology, Duke University Medical Center, Durham, NC 27710, United States of America; Duke Clinical Research Institute, Durham, NC 27710, United States of America. FAU - Morin, Daniel P AU - Morin DP AD - Department of Cardiology, Ochsner Medical Center, New Orleans, LA 70121, United States of America. FAU - Sanders, Gillian D AU - Sanders GD AD - Duke-Margolis Center for Health Policy, Durham, NC 27710, United States of America; Duke Clinical Research Institute, Durham, NC 27710, United States of America; Department of Population Health Sciences, Durham, NC 27710, United States of America. FAU - Al-Khatib, Sana M AU - Al-Khatib SM AD - Division of Cardiology, Duke University Medical Center, Durham, NC 27710, United States of America; Duke Clinical Research Institute, Durham, NC 27710, United States of America. LA - eng GR - R01 HL131754/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Meta-Analysis PT - Research Support, N.I.H., Extramural PT - Systematic Review DEP - 20210420 PL - United States TA - Prog Cardiovasc Dis JT - Progress in cardiovascular diseases JID - 0376442 SB - IM MH - Aged MH - *Cardiac Resynchronization Therapy/adverse effects/mortality MH - *Cardiac Resynchronization Therapy Devices MH - Equipment Design MH - Female MH - Heart Failure/diagnosis/mortality/physiopathology/*therapy MH - Humans MH - Male MH - Middle Aged MH - Recovery of Function MH - Stroke Volume MH - Treatment Outcome MH - Ventricular Function, Left MH - *Ventricular Function, Right MH - Ventricular Remodeling PMC - PMC8667053 MID - NIHMS1755253 OTO - NOTNLM OT - Cardiac resynchronization therapy OT - Right lead location COIS- Declaration of Competing Interest D.P.M. has received research grants from Medtronic and Boston Scientific, consulting fees from Abbott, and speaking fees from Boston Scientific and Zoll. F.A.A: None. F.D: None. G.D.S: None. N.A.L: None. S.M.A. receives research, speaking and consulting fees from Medtronic, research and speaking fees from Abbott, and research fees from Boston Scientific. V.B: None. EDAT- 2021/04/18 06:00 MHDA- 2021/08/31 06:00 PMCR- 2021/12/13 CRDT- 2021/04/17 20:08 PHST- 2021/04/11 00:00 [received] PHST- 2021/04/11 00:00 [accepted] PHST- 2021/04/18 06:00 [pubmed] PHST- 2021/08/31 06:00 [medline] PHST- 2021/04/17 20:08 [entrez] PHST- 2021/12/13 00:00 [pmc-release] AID - S0033-0620(21)00039-6 [pii] AID - 10.1016/j.pcad.2021.04.002 [doi] PST - ppublish SO - Prog Cardiovasc Dis. 2021 May-Jun;66:53-60. doi: 10.1016/j.pcad.2021.04.002. Epub 2021 Apr 20.