Imaging‐guided cardiac resynchronization therapy: A meta‐analysis of randomized controlled trials

• Published in: Pacing and clinical electrophysiology 2021-09, Vol.44 (9), p.1570-1576
• Main Authors: Kheiri, Babikir, Przybylowicz, Ryle, Simpson, Timothy F, Merrill, Miranda, Osman, Mohammed, Dalouk, Khidir, Rahmouni, Hind, Stecker, Eric, Nazer, Babak, Henrikson, Charles A.
• Format: Article
• Language: English
• Subjects: cardiac CT; cardiac MRI; cardiac resynchronization therapy; Cardiac Resynchronization Therapy - methods; Cardiomyopathy; Clinical trials; Congestive heart failure; echocardiography; Heart failure; Humans; Ischemia; left ventricular lead position; Magnetic Resonance Imaging, Interventional; Meta-analysis; multimodality imaging; Patients; Prosthesis Implantation - methods; Radiography, Interventional; Randomized Controlled Trials as Topic; Ultrasonography, Interventional; Ventricle
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/pace.14316

Background Among patients with heart failure and left ventricular (LV) dysfunction despite guideline directed medical therapy, cardiac resynchronization (CRT) is an effective technology to reverse LV remodeling. Given that a large portion of patients are non‐responders, alternatives to traditional LV‐lead placement have been explored. A promising alternative is image targeted placement of an LV‐lead to latest mechanically activated segment without scar. Methods Electronic database search for randomized controlled trials (RCTs) that evaluated the imaging‐guided LV‐lead placement on clinical, echocardiographic, and functional outcomes. The primary outcome was a composite of mortality and heart failure hospitalization. The secondary outcomes included CRT responders, New York Heart Association (NYHA), 6‐minute walk test, Minnesota Living with Heart Failure Questionnaire (MLHFQ), and ejection fraction (EF) changes. Results Analysis included 4 RCTs of 691 patients with an average follow‐up of 2 years (age 69.5 ± 10.3 years, 76% males, 54% ischemic cardiomyopathy, 81% with NYHA classes III/IV, and EF of 24.4% ± 8). The most common site for LV‐lead paced segment was the anterolateral segment (45%) and at mid‐LV (49%). Compared with the control, imaging‐guided LV‐lead placement was associated with a significant reduction of the primary outcome (hazard ratio [HR] = 0.60; 95% CI = 0.40–0.88; p = .01), higher CRT responders (odd ratio [OR] = 2.10; p