Thrombo-embolic events in left ventricular endocardial pacing: long-term outcomes from a multicentre UK registry

Europace. 2018 Dec 1;20(12):1997-2002. doi: 10.1093/europace/euy107.


Aims: Endocardial left ventricular (LV) pacing is a viable alternative in patients with failed coronary sinus (CS) lead implantation. However, long-term thrombo-embolic risk remains unknown. Much of the data have come from a small number of centres. We examined the safety and efficacy of endocardial LV pacing to determine the long-term thrombo-embolic risk.

Methods and results: Registries from four UK centres were combined to include 68 patients with endocardial leads with a mean follow-up of 20 months. These were compared to a matched 1:2 control group with conventional CS leads. Medical records were reviewed, and patients contacted for follow-up. Ischaemic stroke occurred in four patients (6%) in the endocardial arm providing an annual event rate (AER) of 3.6% over a 20 month follow-up; compared to 9 patients (6.6%) amongst controls with an AER of 3.4% over a 23-month follow-up. Regression analyses showed a significant association between sub-therapeutic international normalized ratio and stroke (P = 0.0001) in the endocardial arm. There was no association between lead material and mode of delivery (transatrial/transventricular) and stroke. Mortality rate was 12 and 15 per 100 patient years in the endocardial and control arm respectively with end-stage heart failure being the commonest cause.

Conclusion: Endocardial LV lead in heart failure patients has a good success rate at 1.6 year follow-up. However, it is associated with a thrombo-embolic risk (which is not different from conventional CS leads) attributable to sub-therapeutic anticoagulation. Randomized control trials and studies on non-vitamin K antagonist oral anticoagulants are required to ascertain the potential of widespread clinical application of this therapeutic modality.

Publication types

  • Multicenter Study

MeSH terms

  • Administration, Oral
  • Aged
  • Aged, 80 and over
  • Anticoagulants / administration & dosage
  • Blood Coagulation / drug effects
  • Brain Ischemia / blood
  • Brain Ischemia / diagnosis
  • Brain Ischemia / etiology*
  • Brain Ischemia / prevention & control
  • Cardiac Pacing, Artificial / adverse effects*
  • Cardiac Pacing, Artificial / methods
  • Endocardium / physiopathology*
  • Female
  • Heart Failure / diagnosis
  • Heart Failure / physiopathology
  • Heart Failure / therapy*
  • Heart Ventricles / physiopathology*
  • Humans
  • International Normalized Ratio
  • Male
  • Middle Aged
  • Registries
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • Stroke / blood
  • Stroke / diagnosis
  • Stroke / etiology*
  • Stroke / prevention & control
  • Thromboembolism / blood
  • Thromboembolism / diagnosis
  • Thromboembolism / etiology*
  • Thromboembolism / prevention & control
  • Time Factors
  • Treatment Outcome
  • United Kingdom
  • Ventricular Function, Left*


  • Anticoagulants