Multi-lead pacing for cardiac resynchronization therapy in heart failure: a meta-analysis of randomized controlled trials

Mark K. Elliott; Vishal Mehta; Nadeev Wijesuriya; Baldeep S. Sidhu; Justin Gould; Steven Niederer; Christopher A. Rinaldi

doi:10.1093/ehjopen/oeac013

Multi-lead pacing for cardiac resynchronization therapy in heart failure: a meta-analysis of randomized controlled trials

Mark K. Elliott^*, Vishal Mehta, Nadeev Wijesuriya, Baldeep S. Sidhu, Justin Gould, Steven Niederer, Christopher A. Rinaldi

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

3 Citations (Scopus)

Abstract

Aims Multi-lead pacing is a potential therapy to improve response to cardiac resynchronization therapy (CRT) by providing rapid activation of the myocardium from multiple sites. Here, we perform a meta-analysis of randomized controlled trials to assess the efficacy of multi-lead pacing. Methods and results A literature search was performed which identified 251 unique records. After screening, 6 studies were found to meet inclusion criteria, with 415 patients included in the meta-analysis. Four studies performed multi-lead pacing with two left ventricular (LV) leads and one right ventricular (RV) lead. One study used two RV leads and one LV lead, and one study used both configurations. There was no difference between multi-lead pacing and conventional CRT in LV end-systolic volume [mean difference (MD) -0.54 mL, P = 0.93] or LV ejection fraction (MD 1.42%, P = 0.40). There was a borderline significant improvement in Minnesota Living With Heart Failure Questionnaire score for multi-lead pacing vs. conventional CRT (MD -4.46, P = 0.05), but the difference was not significant when only patients receiving LV-only multi-lead pacing were included (MD -3.59, P = 0.25). There was also no difference between groups for 6-min walk test (MD 15.06 m, P = 0.38) or New York Heart Association class at follow-up [odds ratio (OR) 1.49, P = 0.24]. There was no difference in mortality between groups (OR 1.11, P = 0.77). Conclusion This meta-analysis does not support the use of multi-lead pacing for CRT delivery. However, significant variation between studies was noted, and therefore a benefit for multi-lead pacing in select patients cannot be excluded, and further investigation may be warranted.

Original language	English
Article number	oeac013
Journal	European heart journal open
Volume	2
Issue number	2
DOIs	https://doi.org/10.1093/ehjopen/oeac013
Publication status	Published - 1 Mar 2022

Keywords

Cardiac resynchronization therapy
Heart failure
Multi-lead pacing
Multi-site pacing
Triventricular pacing

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10.1093/ehjopen/oeac013

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@article{952635da53b94d27ab3b8f9ce7d7a472,

title = "Multi-lead pacing for cardiac resynchronization therapy in heart failure: a meta-analysis of randomized controlled trials",

abstract = "Aims Multi-lead pacing is a potential therapy to improve response to cardiac resynchronization therapy (CRT) by providing rapid activation of the myocardium from multiple sites. Here, we perform a meta-analysis of randomized controlled trials to assess the efficacy of multi-lead pacing. Methods and results A literature search was performed which identified 251 unique records. After screening, 6 studies were found to meet inclusion criteria, with 415 patients included in the meta-analysis. Four studies performed multi-lead pacing with two left ventricular (LV) leads and one right ventricular (RV) lead. One study used two RV leads and one LV lead, and one study used both configurations. There was no difference between multi-lead pacing and conventional CRT in LV end-systolic volume [mean difference (MD) -0.54 mL, P = 0.93] or LV ejection fraction (MD 1.42%, P = 0.40). There was a borderline significant improvement in Minnesota Living With Heart Failure Questionnaire score for multi-lead pacing vs. conventional CRT (MD -4.46, P = 0.05), but the difference was not significant when only patients receiving LV-only multi-lead pacing were included (MD -3.59, P = 0.25). There was also no difference between groups for 6-min walk test (MD 15.06 m, P = 0.38) or New York Heart Association class at follow-up [odds ratio (OR) 1.49, P = 0.24]. There was no difference in mortality between groups (OR 1.11, P = 0.77). Conclusion This meta-analysis does not support the use of multi-lead pacing for CRT delivery. However, significant variation between studies was noted, and therefore a benefit for multi-lead pacing in select patients cannot be excluded, and further investigation may be warranted.",

keywords = "Cardiac resynchronization therapy, Heart failure, Multi-lead pacing, Multi-site pacing, Triventricular pacing",

author = "Elliott, {Mark K.} and Vishal Mehta and Nadeev Wijesuriya and Sidhu, {Baldeep S.} and Justin Gould and Steven Niederer and Rinaldi, {Christopher A.}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.",

year = "2022",

month = mar,

day = "1",

doi = "10.1093/ehjopen/oeac013",

language = "English",

volume = "2",

journal = "European heart journal open",

issn = "2752-4191",

publisher = "Oxford University Press",

number = "2",

}

TY - JOUR

T1 - Multi-lead pacing for cardiac resynchronization therapy in heart failure

T2 - a meta-analysis of randomized controlled trials

AU - Elliott, Mark K.

AU - Mehta, Vishal

AU - Wijesuriya, Nadeev

AU - Sidhu, Baldeep S.

AU - Gould, Justin

AU - Niederer, Steven

AU - Rinaldi, Christopher A.

N1 - Publisher Copyright: © The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology.

PY - 2022/3/1

Y1 - 2022/3/1

N2 - Aims Multi-lead pacing is a potential therapy to improve response to cardiac resynchronization therapy (CRT) by providing rapid activation of the myocardium from multiple sites. Here, we perform a meta-analysis of randomized controlled trials to assess the efficacy of multi-lead pacing. Methods and results A literature search was performed which identified 251 unique records. After screening, 6 studies were found to meet inclusion criteria, with 415 patients included in the meta-analysis. Four studies performed multi-lead pacing with two left ventricular (LV) leads and one right ventricular (RV) lead. One study used two RV leads and one LV lead, and one study used both configurations. There was no difference between multi-lead pacing and conventional CRT in LV end-systolic volume [mean difference (MD) -0.54 mL, P = 0.93] or LV ejection fraction (MD 1.42%, P = 0.40). There was a borderline significant improvement in Minnesota Living With Heart Failure Questionnaire score for multi-lead pacing vs. conventional CRT (MD -4.46, P = 0.05), but the difference was not significant when only patients receiving LV-only multi-lead pacing were included (MD -3.59, P = 0.25). There was also no difference between groups for 6-min walk test (MD 15.06 m, P = 0.38) or New York Heart Association class at follow-up [odds ratio (OR) 1.49, P = 0.24]. There was no difference in mortality between groups (OR 1.11, P = 0.77). Conclusion This meta-analysis does not support the use of multi-lead pacing for CRT delivery. However, significant variation between studies was noted, and therefore a benefit for multi-lead pacing in select patients cannot be excluded, and further investigation may be warranted.

AB - Aims Multi-lead pacing is a potential therapy to improve response to cardiac resynchronization therapy (CRT) by providing rapid activation of the myocardium from multiple sites. Here, we perform a meta-analysis of randomized controlled trials to assess the efficacy of multi-lead pacing. Methods and results A literature search was performed which identified 251 unique records. After screening, 6 studies were found to meet inclusion criteria, with 415 patients included in the meta-analysis. Four studies performed multi-lead pacing with two left ventricular (LV) leads and one right ventricular (RV) lead. One study used two RV leads and one LV lead, and one study used both configurations. There was no difference between multi-lead pacing and conventional CRT in LV end-systolic volume [mean difference (MD) -0.54 mL, P = 0.93] or LV ejection fraction (MD 1.42%, P = 0.40). There was a borderline significant improvement in Minnesota Living With Heart Failure Questionnaire score for multi-lead pacing vs. conventional CRT (MD -4.46, P = 0.05), but the difference was not significant when only patients receiving LV-only multi-lead pacing were included (MD -3.59, P = 0.25). There was also no difference between groups for 6-min walk test (MD 15.06 m, P = 0.38) or New York Heart Association class at follow-up [odds ratio (OR) 1.49, P = 0.24]. There was no difference in mortality between groups (OR 1.11, P = 0.77). Conclusion This meta-analysis does not support the use of multi-lead pacing for CRT delivery. However, significant variation between studies was noted, and therefore a benefit for multi-lead pacing in select patients cannot be excluded, and further investigation may be warranted.

KW - Cardiac resynchronization therapy

KW - Heart failure

KW - Multi-lead pacing

KW - Multi-site pacing

KW - Triventricular pacing

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U2 - 10.1093/ehjopen/oeac013

DO - 10.1093/ehjopen/oeac013

M3 - Article

AN - SCOPUS:85147655383

SN - 2752-4191

VL - 2

JO - European heart journal open

JF - European heart journal open

IS - 2

M1 - oeac013

ER -

Multi-lead pacing for cardiac resynchronization therapy in heart failure: a meta-analysis of randomized controlled trials

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