Abstract 9011: Randomized Study of Endovascular versus Epicardial Lead Placement for Resynchronization Therapy (REVERT)

Abstract

Introduction: Cardiac resynchronization therapy (CRT) is used to treat heart failure (HF) with prolonged QRS, with the LV lead typically placed transvenously (TV). Because CRT benefit correlates with concordant placement of the LV lead at the site of latest contraction, we hypothesized that epicardial (EPI) lead placement using a (robotic) surgical approach would afford more consistent access to the optimal site and result in improved clinical outcomes. The REVERT trial is the first prospective randomized clinical trial comparing EPI to TV lead placement for CRT. Methods: Twenty six pts (67.7 ± 8.7 yrs; EF 21.8 ± 8.2 %; QRS 159.5 ± 14 ms) with NYHA class III/IV HF were randomized to an EPI (n=12) or TV (n=14) LV lead implantation guided by preoperative echo dyssynchrony studies. Pts in both groups had similar baseline characteristics. Results: Compared to TV pts, EPI pts were slightly more likely to have LV lead placed concordantly (91% vs 71%, p= 0.34). However, the primary endpoint of LV end systolic volume index at 12 mos improved similarly in each group (Figure). There was also no difference in 2° endpoints at 12 mos (Table). Conclusions: In this randomized trial of primary CRT implantation, EPI LV lead placement, despite high concordancy, did not result in improved clinical outcomes vs TV lead placement.