SPC365

Septal vs. apical cardioverter-defibrillator right ventricle electrode placement – a systematic review on long-term follow-up

Session: CO 11- Síncope
Speaker: Hélder Santos

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.2 Implantable Cardioverter / Defibrillator
Session Type: Comunicações Orais
FP Number: ---
Authors: Helder Santos; Mariana Santos; Ines Almeida; Paula Sofia Paula; Margarida Figueiredo; Guilherme Portugal; Bruno Valente; Pedro Cunha; Micaela Neto; Lurdes Almeida; Mário Oliveira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Background: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">The optimal right ventricular (RV) defibrillator lead placement is still a debatable matter. </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">We attempt to performed a systemic review to evaluate whether septal and apical placement had significant differences in the implantation parameters and during follow-up. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Objective: </span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Review the evidence regarding the efficacy and safety of apical and septal RV defibrillator lead placement. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> A systemic search on MEDLINE and PUBMED databases with the terms &ldquo;septal pacing&rdquo;, &ldquo;apical pacing&rdquo; &ldquo;septal defibrillation&rdquo; and &ldquo;apical defibrillation&rdquo;. A total of 309 results was identified and subsequently selected after a serious analysis, just comparisons with long-term follow up was included. Comparisons between apical and septal placement were performed regarding R-wave amplitude, pacing threshold at a pulse width of 0.5 ms, pacing and shock lead impedance, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDD) and lead complications. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif"> A total of 6 studies with &gt; 1 year follow-up comprising 2180 patients was included in the analysis. The studies were performed with different techniques, analyses and goals, and presented heterogeneous results. Mean age was 64.5 years, 76.9% were male, with a median LVEF of 27.8%, NYHA class of 2.65, ischemic etiologic in 51.1% and a mean follow-up period of 26.5 months. Apical lead placement was performed in 1399 patients while the septal lead placement was established in 772 patients. No differences regarding the lead performance on apical and septal placement were detected regarding the R-wave (MD -0.36, CI -0.75 - +0.03,<em> p</em>=0.68, I<sup>2</sup> = 0%) (reported in 3 studies, graph&nbsp;1) and lead impedance (MD -23.83, CI -51.36 - +3.69,<em> p</em>=0.003, I<sup>2</sup> = 82%) (reported in 3 studies, graph&nbsp;2). Pacing threshold showed values in favour of a septal defibrillator lead implantation (MD -0.05, CI -0.09 - -0.02,<em> p</em>=0.12, I<sup>2</sup> = 53%) (reported in 3 studies, graph 3). Regarding echocardiography parameters during the follow-up period, LVEF (MD -0.83, CI -3.05 - +1.38,<em> p</em>=0.10, I<sup>2</sup> = 57%) (reported in 3 studies, graph&nbsp;4) and LVEDD (MD -0.51, CI -2.13 - +1.10,<em> p</em>=0.20, I<sup>2</sup> = 38%) (reported in 3 studies, graph 5) were not significant influenced by the defibrillator lead placement. Lead complications rate causing lead replacement was not significant different between the lead placement (MD 1.25, CI 0.53 &ndash; 2.94,<em> p</em>=0.71, I<sup>2</sup> = 0%) (reported in 3 studies, graph&nbsp;6). </span></span></span></span></p>

<p><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusions</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Among patients receiving a defibrillator lead, only pacing threshold showed results in favour of septal lead placement. The comparison between apical and septal RV location did not affect significantly other lead parameters, lead performance or echocardiography results during the long-term follow-up. Therefore, potential risks and benefits of RV defibrillator placement should be carefully weighed.</span></span></p>