Cardiovascular Implantable Electronic Devices -> Leads & Electrodes: -> Implantation D-AB06 - Cardiac Resynchronization - LV and His Bundle Pacing! (ID 25) Abstract

D-AB06-06 - Conventional Approach Versus Imaging Guided Left Ventricular Lead Placement During Cardiac Resynchronization Therapy: A Systematic Review And Meta-analysis (ID 775)


Background: Left ventricular (LV) pacing site has emerged as an important factor in cardiac resynchronization therapy (CRT) response, with lead placement in scar area being associated with poor response.
Objective: We sought to compare image versus fluoroscopy guided LV lead placement in this systematic review and meta-analysis.
Methods: A comprehensive literature search from inception until November 9, 2019 was performed. Studies reporting clinical outcomes comparing image vs fluoroscopy guided LV lead placement during CRT implantation were included. Imaging group received periprocedural cardiac imaging (cardiac computed tomography (CT), myocardial perfusion imaging and/or speckle-tracking echocardiography.
Results: A total of 675 patients were included from 4 studies (imaging group, n=347, fluoroscopy group, n=328). Mean age was 70 ± 2.36 years. Mean LV ejection fraction (EF) was 26 ±2.73%. Ischemic cardiomyopathy was present in 54.5 ± 6.48%. Imaging guided LV lead placement was associated with improvements in 6-minute walk test (6MWT) [MD23.47,95% CI 11.41- 35.53, p=0.0001] and EF [MD-2.23, 95% CI -3.59- -0.85, p=0.001] compared to fluoroscopy guided placement. No difference between groups was observed in the Minnesota Living with Heart Failure Questionnaire (MLHFQ) [MD-2.95, 95% CI -6.32- 0.41, p=0.09], New York Heart Association class [RR1.14, 95% CI 1.00-1.30, p=0.06], and total procedure time [MD 4.67, 95% CI -0.64- 9.98, p=0.08].
Conclusion: Image guided LV lead placement was associated with improvements in 6MWT and EF as compared to conventional approach.