Right ventricular apical versus non-apical implantable cardioverter defibrillator lead: A systematic review and meta-analysis

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.