{"id":"933454326775","type":"article","url":"https://hartvaat.nl/2023/08/02/gerichte-lv-leadplaatsing-bij-crt-meta-analyse-van-beeldvorming-en-elektrisch-ge/","title":"Gerichte LV-leadplaatsing bij CRT: meta-analyse van beeldvorming- en elektrisch geleide benaderingen","title_en":"Targeted left ventricular lead positioning to the site of latest activation in cardiac resynchronization therapy: a systematic review and meta-analysis.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euad267","source_url":"https://doi.org/10.1093/europace/euad267","authors":["Daniel Benjamin Fyenbo","Henrik Laurits Bjerre","Maria Hee Jung Park Frausing","Charlotte Stephansen","Anders Sommer","Rasmus Borgquist","Zoltan Bakos","Michael Glikson","Anat Milman","Roy Beinart","Radka Kockova","Kamil Sedlacek","Dan Wichterle","Samir Saba","Sandeep Jain","Alaa Shalaby","Mads Brix Kronborg","Jens Cosedis Nielsen"],"significance":7,"published":"2023-08-02","source_date":"2023-08-02","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/crt-cardiale-resynchronisatietherapie/"],"congress":"","summary_en":"This meta-analysis confirmed that targeted LV lead placement at the site of latest electrical activation improves CRT response compared with empirical positioning, supporting imaging or electrical mapping-guided lead deployment.","created":"2026-07-03T10:30:31Z","updated":"2026-07-03T13:29:35Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Meta-analyse bevestigde dat gerichte LV-leadplaatsing op de site van laatste activering de CRT-respons verbetert vergeleken met empirische positionering. Beeldvorming- en elektrisch geleide strategieën verhogen het percentage responders.","abstract_original":"AIMS: Several studies have evaluated the use of electrically- or imaging-guided left ventricular (LV) lead placement in cardiac resynchronization therapy (CRT) recipients. We aimed to assess evidence for a guided strategy that targets LV lead position to the site of latest LV activation. METHODS AND RESULTS: A systematic review and meta-analysis was performed for randomized controlled trials (RCTs) until March 2023 that evaluated electrically- or imaging-guided LV lead positioning on clinical and echocardiographic outcomes. The primary endpoint was a composite of all-cause mortality and heart failure hospitalization, and secondary endpoints were quality of life, 6-min walk test (6MWT), QRS duration, LV end-systolic volume, and LV ejection fraction. We included eight RCTs that comprised 1323 patients. Six RCTs compared guided strategy (n = 638) to routine (n = 468), and two RCTs compared different guiding strategies head-to-head: electrically- (n = 111) vs. imaging-guided (n = 106). Compared to routine, a guided strategy did not significantly reduce the risk of the primary endpoint after 12-24 (RR 0.83, 95% CI 0.52-1.33) months. A guided strategy was associated with slight improvement in 6MWT distance after 6 months of follow-up of absolute 18 (95% CI 6-30) m between groups, but not in remaining secondary endpoints. None of the secondary endpoints differed between the guided strategies. CONCLUSION: In this study, a CRT implantation strategy that targets the latest LV activation did not improve survival or reduce heart failure hospitalizations."}