Right Ventricular Apical Versus Non-Apical Implantable Cardioverter Defibrillator Lead: a Systematic Review and Meta-Analysis.

Authors

Jalaj Garg MD, Lehigh Valley Health NetworkFollow
Rahul Chaudhary MD
Neeraj Shah MD, Lehigh Valley Health NetworkFollow
Chandrasekar Palaniswamy MD
Babak Bozorgnia MD, Lehigh Valley Health NetworkFollow
Talha Nazir MD, Lehigh Valley Health NetworkFollow
Valentina Kutyifa MD, PhD

Publication/Presentation Date

5-2017

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 3 years”, “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 1 year (OR 0.88; 95% CI 0.51–1.49, p = 0.63; I² = 5.32%). Similarly, no differences were seen between the two groups in death at 3 years (OR = 0.76; 95%CI 0.56–1.04, p = 0.08; I² = 0%), total number of shocks (OR 0.99; 95% CI 0.81–1.22, p = 0.95; I² = 0%), appropriate shocks (OR 1.00; 95% CI 0.79–1.27, p = 0.99; I² = 0%), inappropriate shocks (OR 0.98; 95% CI 0.70–1.37, p = 0.91; I² = 0%) and cut-to-suture time (Standard mean difference = −0.03; 95%CI -0.20 to 0.14, p = 0.73 I² = 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.

Published In/Presented At

Garg, J. Chaudhary, R. Shah, N. Palaniswamy, C. Bozorgnia, B. Nazir, T. Kutyifa, V. (2017). Right Ventricular Apical Versus Non-Apical Implantable Cardioverter Defibrillator Lead: a Systematic Review and Meta-Analysis. Journal of Electrocardiology.

Disciplines

Cardiology | Medical Sciences | Medicine and Health Sciences

Department(s)

Department of Medicine, Cardiology Division, Department of Medicine Faculty, Department of Medicine Fellows and Residents

Document Type

Article