Title

Right vVentricular Apical Versus Non-Apical Implantable Cardioverter Defibrillator lead: A Systematic Review and Meta-Analysis.

Publication/Presentation Date

5-18-2017

Abstract

INTRODUCTION: We aimed to study the effect of right ventricular implantable cardioverter defibrillator (ICD) lead positioning on clinical outcomes in patients undergoing ICD placement.

METHODS: A systematic literature search was performed using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to identify clinical trials comparing outcomes in patients with ICD leads in apical and non-apical positions. The primary outcome of our study was death at 1-year follow-up. Secondary outcomes studied were "death at 3years", "total number of shocks", "appropriate shocks", "inappropriate shocks" and "cut-to-suture time".

RESULTS: We analyzed a total of 3731 patients (2852 in apical and 879 in non-apical ICD groups) enrolled in 4 clinical trials. No significant difference was observed between the apical and non-apical ICD groups in all-cause mortality at 1year (OR 0.88; 95% CI 0.51-1.49, p=0.63; I(2)=5.32%). Similarly, no differences were seen between the two groups in death at 3years (OR=0.76; 95% CI 0.56-1.04, p=0.08; I(2)=0%), total number of shocks (OR 0.99; 95% CI 0.81-1.22, p=0.95; I(2)=0%), appropriate shocks (OR 1.00; 95% CI 0.79-1.27, p=0.99; I(2)=0%), inappropriate shocks (OR 0.98; 95% CI 0.70-1.37, p=0.91; I(2)=0%) and cut-to-suture time (Standard mean difference=-0.03; 95% CI -0.20 to 0.14, p=0.73; I(2)=0%). No publication bias was seen.

CONCLUSION: Non-apical RV ICD lead implantation is non-inferior to traditional RV apical position with no significant differences in mortality, total number of shocks, appropriate shocks, inappropriate shocks and procedural time.

Volume

50

Issue

4

First Page

389

Last Page

538

ISSN

1532-8430

Disciplines

Cardiology | Medical Sciences | Medicine and Health Sciences

PubMedID

28554513

Department(s)

Department of Medicine, Cardiology Division, Department of Medicine Faculty

Document Type

Article