Systematic review and meta‐analysis of left ventricular endocardial pacing in advanced heart failure: Clinically efficacious but at what cost?
Abstract: Introduction: Cardiac resynchronization using a left ventricular (LV) epicardial lead placed in the coronary sinus is now routinely used in the management of heart failure patients. LV endocardial pacing is an alternative when this is not feasible, with outcomes data sparse. Objective: To...
| Publicado en: | Pacing & Clinical Electrophysiology Vol. 41; no. 4; pp. 353 - 362 |
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| Autores principales: | , , , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Wiley-Blackwell
Apr2018
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=129103148&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 129103148 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01478389 4F8 jtl: Pacing & Clinical Electrophysiology issn: 01478389 maglogo: Y pubinfo: dt: Apr2018 vid: 41 iid: 4 pid: 480 pub: Wiley-Blackwell place: Malden, Massachusetts artinfo: ui: 129103148 129103148 129103148 10.1111/pace.13275 129103148 ppf: 353 ppct: 9 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Systematic review and meta‐analysis of left ventricular endocardial pacing in advanced heart failure: Clinically efficacious but at what cost? aug: au: Graham, Adam J. Providenica, Rui Honarbakhsh, Shohreh Srinivasan, Neil Sawhney, Vinit Hunter, Ross Lambiase, Pier affil: Clinical Research Fellow, Barts Heart Centre, West Smithfield, London, EC1A 7BE, UK sug: subj: Heart Failure Therapy Cardiac Pacing, Artificial Methods Heart Ventricle, Left Treatment Outcomes Cardiac Pacing, Artificial Adverse Effects Human Systematic Review Meta Analysis Cardiac Resynchronization Therapy Coronary Vessels Medline Embase Cochrane Library Ventricular Ejection Fraction QRS Complex Descriptive Statistics Confidence Intervals P-Value Mortality Heart Failure Classification Stroke Diagnosis Electrodes Stroke Risk Factors ab: Abstract: Introduction: Cardiac resynchronization using a left ventricular (LV) epicardial lead placed in the coronary sinus is now routinely used in the management of heart failure patients. LV endocardial pacing is an alternative when this is not feasible, with outcomes data sparse. Objective: To review the available evidence on the efficacy and safety of endocardial LV pacing via meta‐analysis. Methods: EMBASE, MEDLINE, and COCHRANE databases with the search term “endocardial biventricular pacing” or “endocardial cardiac resynchronization” or “left ventricular endocardial” or “endocardial left ventricular.” Comparisons of pre‐and post‐QRS width, LV ejection fraction (LVEF), and New York Heart Association (NYHA) functional classification was performed, and mean differences (and respective 95% confidence interval [CI]) applied as a measurement of treatment effect. Results: Fifteen studies, including 362 patients, were selected. During a mean follow‐up of 40 ± 24.5 months, death occurred in 72 patients (11 per 100 patient‐years). Significant improvements in LVEF (mean difference 7.9%, 95% CI 5–10%, P < 0.0001; I2 = 73%), QRS width (mean difference: –41% 95% –75 to –7%; P < 0.0001; I2 = 94%), and NYHA class (mean difference: –1.06, 95% CI –1.2 to –0.9, P < 0.0001; I2 = 60%), (all P < 0.0001) occurred. Stroke rate was 3.3–4.2 per 100 patient‐years, which is higher than equivalent heart failure trial populations and recent meta‐analysis that included small case series. Conclusion: 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. pubtype: Academic Journal doctype: meta analysis research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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