Systematic review and meta‐analysis of left ventricular endocardial pacing in advanced heart failure: Clinically efficacious but at what cost?

Introduction Cardiac resynchronization using a left ventricular (LV) epicardial lead placed in the coronary sinus is now routinely used in the management of heart failure patients. LV endocardial pacing is an alternative when this is not feasible, with outcomes data sparse. Objective To review the available evidence on the efficacy and safety of endocardial LV pacing via meta‐analysis. Methods EMBASE, MEDLINE, and COCHRANE databases with the search term “endocardial biventricular pacing” or “endocardial cardiac resynchronization” or “left ventricular endocardial” or “endocardial left ventricular.” Comparisons of pre‐and post‐QRS width, LV ejection fraction (LVEF), and New York Heart Association (NYHA) functional classification was performed, and mean differences (and respective 95% confidence interval [CI]) applied as a measurement of treatment effect. Results Fifteen studies, including 362 patients, were selected. During a mean follow‐up of 40 ± 24.5 months, death occurred in 72 patients (11 per 100 patient‐years). Significant improvements in LVEF (mean difference 7.9%, 95% CI 5–10%, P