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COMPARATIVE EFFECTIVENESS OF LEFT VENTRICULAR VERSUS BIVENTRICULAR PACING FOR CARDIAC RESYNCHRONIZATION THERAPY: A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
A317 JACC April 1, 2014 Volume 63, Issue 12
Arrhythmias and Clinical EP Comparative Effectiveness of Left Ventricular versus Biventricular Pacing for Cardiac Resynchronization Therapy: A Meta-Analysis of Randomized Controlled Trials Poster Contributions Hall C Saturday, March 29, 2014, 10:00 a.m.-10:45 a.m.
Session Title: Device Therapies in Heart Failure and Cardiomyopathies Abstract Category: 8. Arrhythmias and Clinical EP: Devices Presentation Number: 1108-107 Authors: Pasquale Santangeli, Andrew Epstein, Mathew Hutchinson, Erica Zado, Daniele Muser, David J. Callans, Francis Marchlinski, University of Pennsylvania, Philadelphia, PA, USA Background: Cardiac resynchronization therapy (CRT) reduces symptoms and improves survival in patients with severe left ventricular (LV) dysfunction and a prolonged QRS duration. The extent to which such benefit is due to biventricular (BV) versus LV pacing is unclear. This systematic review and meta-analysis of randomized trials compares BV versus LV-only pacing in patients undergoing CRT. Methods: We searched PubMed, CENTRAL, BioMedCentral, Embase, Cardiosource, clinicaltrials.gov, and ISI Web of Science for randomized controlled trials specifically designed to compare BV with LV-only pacing in patients undergoing CRT. Data regarding all-cause mortality or heart transplantation, hospitalization, LV ejection fraction (LVEF), and exercise tolerance (i.e., 6-minute walk test, 6MWT) were extracted. Odds ratios (OR) and weighted mean difference (WMD) with their 95% confidence intervals (CI) were calculated and pooled using a random-effect model. Results: We identified 8 trials that enrolled 786 patients (age 63.3 ± 2.9 years, 73% males) with severe LV dysfunction (LVEF 23.4 ± 1.9%; 57% ischemic cardiomyopathy; average QRS duration 173 ± 18 ms). 342 (43%) patients were randomized to LV-only pacing. The mean follow-up duration was 6.5 ± 4.1 mo. On pooled analysis, no difference was found between LV-only and BV pacing for the endpoints of death or heart transplantation (OR 1.12, 95% CI 0.53 to 2.39, P = 0.77), and hospitalization (OR 0.46, 95% CI 0.09 to 2.26, P = 0.34). Compared to BV pacing, LV-only pacing provided similar improvements in LVEF (mean increase 5.3±1.1% vs. 6.4±2.9%, respectively; WMD -0.98, 95% CI -2.47 to 0.51, P = 0.19) and exercise tolerance at the 6MWT (mean increase 46.4±24.6 m vs. 51.9±20.4 m, respectively; WMD -4.43, 95% CI -15.46 to 6.59, P = 0.43). Conclusions: LV-only pacing provides similar benefits to BV pacing in terms of all-cause mortality, need for transplantation, hospitalization, improvement in LVEF and exercise tolerance. In patients treated with CRT who are not pacemaker-dependent, LV-only pacing is an alternative to increase battery longevity.
Arrhythmias and Clinical EP Comparative Effectiveness of Left Ventricular versus Biventricular Pacing for Cardiac Resynchronization Therapy: A Meta-Analysis of Randomized Controlled Trials Poster Contributions Hall C Saturday, March 29, 2014, 10:00 a.m.-10:45 a.m.
Session Title: Device Therapies in Heart Failure and Cardiomyopathies Abstract Category: 8. Arrhythmias and Clinical EP: Devices Presentation Number: 1108-107 Authors: Pasquale Santangeli, Andrew Epstein, Mathew Hutchinson, Erica Zado, Daniele Muser, David J. Callans, Francis Marchlinski, University of Pennsylvania, Philadelphia, PA, USA Background: Cardiac resynchronization therapy (CRT) reduces symptoms and improves survival in patients with severe left ventricular (LV) dysfunction and a prolonged QRS duration. The extent to which such benefit is due to biventricular (BV) versus LV pacing is unclear. This systematic review and meta-analysis of randomized trials compares BV versus LV-only pacing in patients undergoing CRT. Methods: We searched PubMed, CENTRAL, BioMedCentral, Embase, Cardiosource, clinicaltrials.gov, and ISI Web of Science for randomized controlled trials specifically designed to compare BV with LV-only pacing in patients undergoing CRT. Data regarding all-cause mortality or heart transplantation, hospitalization, LV ejection fraction (LVEF), and exercise tolerance (i.e., 6-minute walk test, 6MWT) were extracted. Odds ratios (OR) and weighted mean difference (WMD) with their 95% confidence intervals (CI) were calculated and pooled using a random-effect model. Results: We identified 8 trials that enrolled 786 patients (age 63.3 ± 2.9 years, 73% males) with severe LV dysfunction (LVEF 23.4 ± 1.9%; 57% ischemic cardiomyopathy; average QRS duration 173 ± 18 ms). 342 (43%) patients were randomized to LV-only pacing. The mean follow-up duration was 6.5 ± 4.1 mo. On pooled analysis, no difference was found between LV-only and BV pacing for the endpoints of death or heart transplantation (OR 1.12, 95% CI 0.53 to 2.39, P = 0.77), and hospitalization (OR 0.46, 95% CI 0.09 to 2.26, P = 0.34). Compared to BV pacing, LV-only pacing provided similar improvements in LVEF (mean increase 5.3±1.1% vs. 6.4±2.9%, respectively; WMD -0.98, 95% CI -2.47 to 0.51, P = 0.19) and exercise tolerance at the 6MWT (mean increase 46.4±24.6 m vs. 51.9±20.4 m, respectively; WMD -4.43, 95% CI -15.46 to 6.59, P = 0.43). Conclusions: LV-only pacing provides similar benefits to BV pacing in terms of all-cause mortality, need for transplantation, hospitalization, improvement in LVEF and exercise tolerance. In patients treated with CRT who are not pacemaker-dependent, LV-only pacing is an alternative to increase battery longevity.