https://doi.org/10.4081/monaldi.2024.2845
Assessing cardiac resynchronization therapy response in heart failure patients: a comparative analysis of efficacy and outcomes between transvenous and epicardial leads
Submitted: November 9, 2023
Accepted: January 23, 2024
Published: February 7, 2024
Accepted: January 23, 2024
Abstract Views: 977
PDF_EARLY VIEW: 162
SUPPLEMENTARY: 46
SUPPLEMENTARY: 46
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Cardiac resynchronization therapy (CRT) is an effective treatment for selected heart failure (HF) patients. Although transvenous implantation is the standard method, it is not feasible in some patients, so the epicardial lead emerges as an alternative. We aim to compare CRT response, procedure-related complications, and the occurrence of clinical outcomes between patients with transvenous and epicardial leads. In a single-center retrospective study, we enrolled consecutive HF patients submitted to CRT implantation with a defibrillator between 2013 and 2022. Clinical response was defined as an improvement of at least one of the New York Heart Association classes with no occurrence of cardiovascular death or HF hospitalization in the first year of follow-up. Echocardiographic response was attained with an increase in left ventricular ejection fraction 10% or a reduction of left ventricular end-diastolic volume >15% at 6-12 months after CRT implantation. Major adverse cardiovascular events (MACE) (cardiovascular mortality and HF hospitalization) and all-cause mortality were evaluated. From a total of 149 patients, 38% (n=57) received an epicardial lead. Clinical (63% versus 60%, p=0.679) and echocardiographic (63% versus 60%, p=0.679) responses were similar between the transvenous and epicardial groups. Patients in the transvenous group had a shorter hospital stay (2 versus 7 days, p<0.001). Procedure-related complications were comparable between groups (24% versus 28%, p=0.572), but left ventricular lead-related complications were more frequent in the transvenous group (14% versus 2%). During a median follow-up of 4.7 years, the rate of MACE was 30% (n=44), with no differences in both groups (p=0.591), neither regarding HF hospitalization (p=0.917) nor cardiovascular mortality (p=0.060). Nevertheless, the epicardial group had a higher rate of all-cause mortality (35% versus 20%, p=0.005), the majority occurring during long-term follow-up (>12 months), with no deaths in the postoperative period. Considering the comparable rates of CRT response, procedure-related complications, and MACE between groups, we conclude that epicardial lead is a feasible alternative for CRT when transvenous lead implantation is not possible. The occurrence of a higher number of all-cause deaths in epicardial patients in the long-term follow-up was mainly due to infectious complications (unrelated to the lead) and the progression of oncological/chronic diseases.
McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42:3599-726.
DOI: https://doi.org/10.1093/eurheartj/ehab670
Cleland JG, Abraham WT, Linde C, et al. An individual patient meta-analysis of five randomized trials assessing the effects of cardiac resynchronization therapy on morbidity and mortality in patients with symptomatic heart failure. Eur Heart J 2013;34:3547-56.
DOI: https://doi.org/10.1093/eurheartj/eht290
Cleland JGF, Freemantle N, Erdmann E, et al. Long‐term mortality with cardiac resynchronization therapy in the cardiac resynchronization‐heart failure (CARE‐HF) trial. Eur J Heart Fail 2012;14:628-34.
DOI: https://doi.org/10.1093/eurjhf/hfs055
Sohaib SMA, Finegold JA, Nijjer SS, et al. Opportunity to Increase life span in narrow QRS cardiac resynchronization therapy recipients by deactivating ventricular pacing. JACC Heart Fail 2015;3:327-36.
DOI: https://doi.org/10.1016/j.jchf.2014.11.007
Zhu H, Zou T, Zhong Y, et al. Prevention of non-response to cardiac resynchronization therapy: points to remember. Heart Fail Rev 2020;25:269-75.
DOI: https://doi.org/10.1007/s10741-019-09834-w
Burger H, Pecha S, Hakmi S, et al. Five-year follow-up of transvenous and epicardial left ventricular leads: experience with more than 1000 leads. Interact Cardiov Th Surgery 2019;74-80.
DOI: https://doi.org/10.1093/icvts/ivz239
Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J 2021;42:3427-520.
DOI: https://doi.org/10.1093/eurheartj/ehab699
Khan FZ, Virdee MS, Fynn SP, Dutka DP. Left ventricular lead placement in cardiac resynchronization therapy: where and how?. Europace 2009;11:554-61.
DOI: https://doi.org/10.1093/europace/eup076
Buiten MS, Van Der Heijden AC, Klautz RJM, et al. Epicardial leads in adult cardiac resynchronization therapy recipients: a study on lead performance, durability, and safety. Heart Rhythm 2015;12:533-9.
DOI: https://doi.org/10.1016/j.hrthm.2014.11.004
McAloon CJ, Anderson BM, Dimitri W, et al. Long‐Term follow‐up of isolated epicardial left ventricular lead implant using a minithoracotomy approach for cardiac resynchronization therapy. Pacing Clin Electrophisiol 2016;39:1052-60.
DOI: https://doi.org/10.1111/pace.12932
Monteiro V, Gonçalves L, Sanfins V, Chaves JC. Ventricular cardiac resynchronization--initial surgical experience. Rev Port Cir Cardiotorac Vasc 2005;12:149-52. [Article in Portuguese].
Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2015;16:233-71.
DOI: https://doi.org/10.1093/ehjci/jev014
Oki T, Ishii S, Takigami Y, et al. Re-worsening left ventricular ejection fraction after response to cardiac resynchronization therapy. J Cardiol 2022;79:358-64.
DOI: https://doi.org/10.1016/j.jjcc.2021.10.010
Chung ES, Leon AR, Tavazzi L, et al. Results of the Predictors of response to CRT (PROSPECT) trial. Circulation 2008;117:2608-16.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.107.743120
Loutfi M, Nawar M, Eltahan S, Elhoda AA. Predictors of response to cardiac resynchronization therapy in chronic heart failure patients. Egyptian Heart J 2016;68:227-36.
DOI: https://doi.org/10.1016/j.ehj.2016.01.001
Steffel J, Ruschitzka F. Superresponse to cardiac resynchronization therapy. Circulation 2014;130:87-90.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.113.006124
Kim HR, Lim K, Park SJ, et al. Thoracoscopic implantation of epicardial left ventricular lead for cardiac resynchronization therapy. J Cardiovasc Dev Dis 2022;9:160.
DOI: https://doi.org/10.3390/jcdd9050160
Khan FZ, Virdee MS, Palmer CR, et al. Targeted left ventricular lead placement to guide cardiac resynchronization therapy. J Am Coll Cardiol 2012;59:1509-18.
DOI: https://doi.org/10.1016/j.jacc.2011.12.030
Pescariu SA, Şoşdean R, Tudoran C, et al. Echocardiographic Parameters as predictors for the efficiency of resynchronization therapy in patients with dilated cardiomyopathy and HFrEF. Diagnostics (Basel) 2021;12:35.
DOI: https://doi.org/10.3390/diagnostics12010035
Abdelhadi R, Adelstein E, Voigt A, et al. Measures of left ventricular dyssynchrony and the correlation to clinical and echocardiographic response after cardiac resynchronization therapy. Am J Cardiol 2008;102:598-601.
DOI: https://doi.org/10.1016/j.amjcard.2008.04.038
Fornwalt BK, Sprague WW, BeDell P, et al. Agreement Is poor among current criteria used to define response to cardiac resynchronization therapy. Circulation 2010;121:1985-91.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.109.910778
Versteeg H, van't Sant J, Cramer MJ, et al. Discrepancy between echocardiographic and patient‐reported health status response to cardiac resynchronization therapy: results of the PSYHEART-CRT study. Eur J Heart Fail 2014;16:227-34.
DOI: https://doi.org/10.1002/ejhf.38
Boidol J, Średniawa B, Kowalski O, et al. Many response criteria are poor predictors of outcomes after cardiac resynchronization therapy: validation using data from the randomized trial. Europace 2013;15:835-44.
DOI: https://doi.org/10.1093/europace/eus390
Russo E, Russo G, Cassese M, et al. The role of cardiac resynchronization therapy for the management of functional mitral regurgitation. Cells 2022;11:2407.
DOI: https://doi.org/10.3390/cells11152407
Van Bommel RJ, Marsan NA, Delgado V, et al. Cardiac resynchronization therapy as a therapeutic option in patients with moderate-severe functional mitral regurgitation and high operative risk. Circulation 2011;124:912-9.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.110.009803
Rickard J, Johnston DR, Price J, et al. Reverse ventricular remodeling and long-term survival in patients undergoing cardiac resynchronization with surgically versus percutaneously placed left ventricular pacing leads. Heart Rhythm 2015;12:517-23.
DOI: https://doi.org/10.1016/j.hrthm.2014.11.013
Nguyên UC, Prinzen FW, Vernooy K. Left ventricular lead placement in cardiac resynchronization therapy: current data and potential explanations for lack of benefit. Heart Rhythm 2024;21:197-205.
DOI: https://doi.org/10.1016/j.hrthm.2023.10.003
Zanon F, Baracca E, Pastore G, et al. Determination of the longest intrapatient left ventricular electrical delay may predict acute hemodynamic improvement in patients after cardiac resynchronization therapy. Circ Arrhythm Electrophysiol 2014;7:377-83.
DOI: https://doi.org/10.1161/CIRCEP.113.000850
Mendonca Costa C, Neic A, Kerfoot E, et al. Pacing in proximity to scar during cardiac resynchronization therapy increases local dispersion of repolarization and susceptibility to ventricular arrhythmogenesis. Heart Rhythm 2019;16:1475-83.
DOI: https://doi.org/10.1016/j.hrthm.2019.03.027
Saxon LA, Olshansky B, Volosin K, et al. Influence of left ventricular lead location on outcomes in the COMPANION study. Cardiovasc Electrophysiol 2009;20:764-8.
DOI: https://doi.org/10.1111/j.1540-8167.2009.01444.x
Wilton SB, Exner DV, Healey JS, et al. Left ventricular lead position and outcomes in the resynchronization-defibrillation for ambulatory heart failure trial (RAFT). Can J Cardiol 2014;30:413-9.
DOI: https://doi.org/10.1016/j.cjca.2013.10.009
Moss AJ, Hall WJ, Cannom DS, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 2009;361:1329-38.
DOI: https://doi.org/10.1056/NEJMoa0906431
Kydd AC, Khan FZ, Watson WD, et al. Prognostic benefit of optimum left ventricular lead position in cardiac resynchronization therapy. JACC Heart Fail 2014;2:205-12.
DOI: https://doi.org/10.1016/j.jchf.2013.11.010
Sade LE, Saba S, Marek JJ, et al. The association of left ventricular lead position related to regional scar by speckle-tracking echocardiography with clinical outcomes in patients receiving cardiac resynchronization therapy. J Am Soc Echocardiogr 2014;27:648-56.
DOI: https://doi.org/10.1016/j.echo.2014.01.025
Harb SC, Toro S, Bullen JA, et al. Scar burden is an independent and incremental predictor of cardiac resynchronisation therapy response. Open Heart 2019;6:e001067.
DOI: https://doi.org/10.1136/openhrt-2019-001067
Nguyên UC, Mafi-Rad M, Aben JP, et al. A novel approach for left ventricular lead placement in cardiac resynchronization therapy: intraprocedural integration of coronary venous electroanatomic mapping with delayed enhancement cardiac magnetic resonance imaging. Heart Rhythm 2017;14:110-9.
DOI: https://doi.org/10.1016/j.hrthm.2016.09.015
Blendea D, Shah RV, Auricchio A, et al. Variability of coronary venous anatomy in patients undergoing cardiac resynchronization therapy: a high-speed rotational venography study. Heart Rhythm 2007;4:1155-62.
DOI: https://doi.org/10.1016/j.hrthm.2007.05.023
Marini M, Branzoli S, Moggio P, et al. Epicardial left ventricular lead implantation in cardiac resynchronization therapy patients via a video‐assisted thoracoscopic technique: Long‐term outcome. Clin Cardiol 2020;43:284-90.
DOI: https://doi.org/10.1002/clc.23300
Zhao ZQ, Liu T, Zhu XT, et al. Epicardial or transvenous leads: controversial for the placement in implantation of cardiac resynchronization therapy. Int J Cardiol 2016;202:834-5.
DOI: https://doi.org/10.1016/j.ijcard.2015.10.064
Navia JL, Atik FA, Grimm RA, et al. Minimally Invasive left ventricular epicardial lead placement: surgical techniques for heart failure resynchronization therapy. Ann Thorac Surg 2005;79:1536-44.
DOI: https://doi.org/10.1016/j.athoracsur.2004.10.041
Doll N, Piorkowski C, Czesla M, et al. Epicardial versus transvenous left ventricular lead placement in patients receiving cardiac resynchronization therapy: results from a randomized prospective study. Thorac Cardiovasc Surg 2008;56:256-61.
DOI: https://doi.org/10.1055/s-2008-1038633
Miller AL, Kramer DB, Lewis EF, et al. Event-free survival following CRT with surgically implanted lv leads versus standard transvenous approach: surgical versus transvenous CRT leads. Pacing Clin Electrophysiol 2011;34:490-500.
DOI: https://doi.org/10.1111/j.1540-8159.2010.03014.x
Ethics Approval
The study was conducted in accordance with the Declaration of Helsinki and was approved by the local Ethics Committee (approval document no. 155/2023-CAF).How to Cite
Neves Pereira, Maria Tamara, Mariana Tinoco, Margarida Castro, Luísa Pinheiro, Filipa Cardoso, Lucy Calvo, Sílvia Ribeiro, Vitor Monteiro, Victor Sanfins, and António Lourenço. 2024. “Assessing Cardiac Resynchronization Therapy Response in Heart Failure Patients: A Comparative Analysis of Efficacy and Outcomes Between Transvenous and Epicardial Leads”. Monaldi Archives for Chest Disease, February. https://doi.org/10.4081/monaldi.2024.2845.
Copyright (c) 2024 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
Similar Articles
- Rodolfo Citro, Antonello Panza, Paolo Masiello, Amelia Ravera, Lucia Tedesco, Rocco Leone, Marco Mirra, Roberta Giudice, Severino Iesu, Francesco Silvestri, Giuseppe Di Benedetto, Eduardo Bossone, Intramural aortic hematoma: no flap no warning? , Monaldi Archives for Chest Disease: Vol. 76 No. 1 (2011): Cardiac series
- I. Blanco, H. Canto, J. Flóres, C. Camblor, V. Cárcaba, F.J. de Serres, S. Janciauskiene, E.F. Bustillo, Long-term augmentation therapy with Alpha-1 Antitrypsin in an MZ-AAT severe persistent asthma , Monaldi Archives for Chest Disease: Vol. 69 No. 4 (2008): Pulmonary series
- Mauro Di Bari, Alessandra Pratesi, Francesca M. Nigro, Irene Marozzi, Stefano Fumagalli, DAPT plus anticoagulant therapy: The difficult coexistence post-ACS in older patients with atrial fibrillation , Monaldi Archives for Chest Disease: Vol. 88 No. 2 (2018)
- Vittorio Bianchi, Alessandro Mezzani, Androgens and cardiac diseases , Monaldi Archives for Chest Disease: Vol. 80 No. 4 (2013): Cardiac Series
- Gabriella Malfatto, Giovanna Branzi, Caterina Bizzi, Paola Valli, Mario Facchini, Favourable effects of cardiovascular rehabilitation on funcional capacity and autonomic balance in elderly patients with heart failure , Monaldi Archives for Chest Disease: Vol. 64 No. 2 (2005): Cardiac series
- Antonio Cittadini, Roberta D'Assante, Growth hormone in heart failure revisited: An old story retold , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- Nicolò Montali, Marco Bobbio, Enrico Cerrato, Giuseppe Azzaro, Bianca Bianchini, Alessandro Bonzano, Maria Vincenza Calì, Rodolfo Cavaliere, Livio Correndo, Antonella Deorsola, Regine Guillevin, Loredana Mainardi, Laura Montagna, Massimo Pistono, Gian Paolo Trevi, Management of heart failure in Piedmont Region , Monaldi Archives for Chest Disease: Vol. 70 No. 4 (2008): Cardiac series
- Alberto M. Marra, Andrea Salzano, Michele Arcopinto, Lucrezia Piccioli, Valeria Raparelli, The impact of gender in cardiovascular medicine: Lessons from the gender/sex-issue in heart failure , Monaldi Archives for Chest Disease: Vol. 88 No. 3 (2018)
- David Simoni, Martina Rafanelli, Andrea Ungar, Enrico Mossello, Niccolò Marchionni, Samuele Baldasseroni, Neurocognitive profile of patients with continuous flow Left Ventricular Assist Device , Monaldi Archives for Chest Disease: Vol. 82 No. 2 (2014): Cardiac series
- Francesco Vetta, Gabriella Locorotondo, Giampaolo Vetta, Maria Mignano, Sonia Bracchitta, Prognostic impact of frailty in elderly cardiac surgery patients , Monaldi Archives for Chest Disease: Vol. 87 No. 2 (2017)
<< < 1 2 3 4 5 6 7 8 9 10 > >>
You may also start an advanced similarity search for this article.
