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.
Date
2022-01
Editors
Journal Title
Journal ISSN
Volume Title
Repository Usage Stats
views
downloads
Citation Stats
Abstract
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.Type
Department
Description
Provenance
Citation
Permalink
Published Version (Please cite this version)
Publication Info
Allen LaPointe, Nancy M, Fatima Ali-Ahmed, Frederik Dalgaard, Andrzej S Kosinski, Gillian Sanders Schmidler and Sana M Al-Khatib (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. Journal of interventional cardiology, 2022. p. 6285894. 10.1155/2022/6285894 Retrieved from https://hdl.handle.net/10161/25396.
This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.
Collections
Scholars@Duke

Nancy Marie Allen LaPointe
Dr. Allen LaPointe is an Adjunct Associate Professor in Medicine and Faculty Fellow at the Duke-Margolis Center for Health Policy at Duke University. She is a researcher and cardiovascular clinical pharmacist with extensive experience in health outcomes and health services research, evidence synthesis, and the protection of human research subjects. Her clinical and research work have been focused on patient safety, predominately in patients with cardiovascular disease. This includes work in reducing medication errors, improving medication adherence, safely and effectively translating evidence into clinical practice, comparing safety and effectiveness of therapeutics, evaluating risk communication and mitigation strategies, and exploring the interface between health policy and patient safety.
Unless otherwise indicated, scholarly articles published by Duke faculty members are made available here with a CC-BY-NC (Creative Commons Attribution Non-Commercial) license, as enabled by the Duke Open Access Policy. If you wish to use the materials in ways not already permitted under CC-BY-NC, please consult the copyright owner. Other materials are made available here through the author’s grant of a non-exclusive license to make their work openly accessible.