Hellenic journal of cardiology : HJC = Hellenike kardiologike epitheorese 2017 08 01() pii S1109-9666(17)30121-5
Cardiac resynchronization therapy (CRT) device implantation is hampered by difficult placement of the left ventricular (LV) lead. We have routinely employed a steerable electrophysiology catheter to guide coronary sinus (CS) cannulation and facilitate LV lead positioning. The aim of this prospective study is to present our results with this approach in 138 consecutive patients receiving a CRT device over 10 years.
The study included 120 men and 18 women, aged 64.8+11.4 years, with coronary disease (n=63), cardiomyopathy (n=72) or other disease (n=3), and mean ejection fraction 24.5+4.5%. Devices were implanted for refractory heart failure and dyssynchrony, all but two in presence of left bundle branch block. Implanted devices included biventricular pacemakers (CRT-P) (n=33) and cardioverter defibrillators (CRT-D) (n=105).
Using the electrophysiology catheter, the CS could be engaged in 134 (97.1%) patients. In 4 patients failing CS cannulation, a dual-chamber device was implanted in 2, and bifocal right ventricular pacing was effected in 2. Bifocal (n=2) or conventional (n=1) systems were implanted in another 3 patients, in whom the LV lead got dislodged (n=2), or removed due to local dissection (n=1). Thus, finally, a CRT system was successfully established in 131 (94.9%) patients. There were 3 patients with CS dissection, one complicated by tamponade managed with pericardiocentesis. There were no peri-operative deaths. During follow-up (31.0+21.2 months), clinical improvement was reported by 108 (82.4%) patients.
Routine use of an electrophysiology catheter greatly facilitated CS cannulation and successful LV lead placement in ∼95% of patients undergoing CRT system implantation.