Impact of segmental left ventricle lead position on cardiac resynchronization therapy outcomes

Merchant, Faisal M.; Heist, E. Kevin; McCarty, David; Kumar, Payal; Das, Saumya; Blendea, Dan; Ellinor, Patrick T.; Mela, Theofanie; Picard, Michael H.; Ruskin, Jeremy N.; Singh, Jagmeet P.

doi:10.1016/j.hrthm.2010.01.035

Cited by 82 publications

(71 citation statements)

References 26 publications

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“…Our results demonstrated there is a large variability of the coronary venous systems within the study subjects. Currently, it is thought that the positioning of left ventricular pacemaker lead in either posterior-lateral or lateral vein during CRT is associated with better clinical outcome [17,18]. In our study, 19.5% of the patients had neither of these veins.…”

Section: Discussionmentioning

confidence: 50%

Evaluation of Coronary Venous Anatomy by Multislice Computed Tomography

Sun¹,

Yang²,

Lam³

et al. 2012

WJCS

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Background: The coronary venous system is increasingly targeted for pacing in patients with severe heart failure. The recent advancement of Multi-Detector Computed Tomography (MDCT) allows accurate analysis of the coronary arteries, but little data exist on its role in assessing cardiac venous anatomy. The aim of the present study was to investigate the feasibility of using MDCT in evaluating the cardiac venous anatomy in patients with heart disease; Methods and Results: One hundred and eighteen subjects (59 ± 11 years, 100 males) were studied by contrast enhanced 16-slice CT with retrospective ECG-reconstructions. The diameter, length, and angulations of coronary veins were measured from both volume rendered 3-dimensional images and curved multi-planar images. The coronary sinus vein was visualized in all of patients. However, the posterior, postero-lateral, lateral, antero-lateral and anterior veins were found in 71.2%, 50.0%, 65.3%, 9.3% and 96% patients, respectively. Twenty-three (19.5%) subjects had neither postero-lateral nor lateral cardiac veins. The ostial diameter angle of take-off and total length of the postero-lateral and lateral veins ranged from 1.7 -7.0 mm, 38 -160 degrees and 2.6 -10.6 mm, respectively; Conclusions: This study confirms the feasibility of assessing diameter, length, and angulations of coronary veins by MDCT. This non-invasive information should be useful for pre-operative lead placement planning for patients scheduled to have cardiac resynchronization therapy.

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Section: Discussionmentioning

confidence: 50%

Evaluation of Coronary Venous Anatomy by Multislice Computed Tomography

Sun¹,

Yang²,

Lam³

et al. 2012

WJCS

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“…[13][14][15] LV lead implantation into the recommended lateral or posterolateral side branch of the CS is not feasible due to anatomical and/or technical limitations in up to one-third of patients. 16 An important cause of suboptimal lead positioning, lead dislodgement, or extracardiac stimulation is the unstable electrode position in the target vein.…”

Section: Discussionmentioning

confidence: 99%

Long-term experience with coronary sinus side branch stenting to stabilize left ventricular electrode position

et al. 2011

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BACKGROUND Despite technical advancements, implantation of coronary sinus (CS) leads may be challenging, and dislocation remains a relevant clinical problem.OBJECTIVE The aim of this study was to investigate the effectiveness, safety, and long-term outcome of stent implantation to anchor the lead to the wall of the CS side branch. METHODSStenting of a CS side branch was performed in 312 patients. The procedure was performed because of postoperative lead dislocation in 16 patients and because of an intraoperative unstable lead position or phrenic nerve stimulation in 296 cases. A bare metal coronary stent was introduced over a second guide wire in the same CS sheath. The stent was deposited 5-35 mm proximal to the most proximal electrode. Mechanical damage of the CS side branch or pericardial effusion was not observed owing to stenting. RESULTSDuring follow-up (median 28.4, interquartile range 15-37, maximum 70 months), a clinically important increase in the left ventricular pacing threshold was found in four cases and reoperation was necessary in only two patients (0.6%). Phrenic nerve stimulation was observed in 18 instances, and repositioning with an ablation catheter was performed in seven cases. Impedance measurements did not suggest lead insulation failure. Three stented leads were extracted without complication after 3-49 months owing to infection, while four leads were extracted easily during heart transplantation after 7-27 months.CONCLUSION Stent implantation to stabilize CS lead position seems to be an effective and safe procedure in prevention and treatment of CS lead dislocation in selected cases.KEYWORDS Cardiac resynchronization; LV lead implantation; Coronary sinus; Lead dislocation; Stent implantation ABBREVIATIONS CRT ϭ cardiac resynchronization therapy; CS ϭ coronary sinus; INR ϭ international normalized ratio; LV ϭ left ventricle; NYHA ϭ New York Heart Association; PNS ϭ phrenic nerve stimulation (Heart Rhythm 2011;8:845-850)

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“…Apical placement of the LV lead may enhance lead stability but is associated with worst outcomes. 30,31 In the trial, distal LV lead placement increased the risk of death and/or HF hospitalization by a factor of 1.64 and increased the risk of mortality by 2.6. Therefore, LV basal pacing was better.…”

Section: Current Issues With Crt Responsementioning

confidence: 99%

How to Define Cardiac Resynchronization Therapy Response

Tomassoni¹

2016

JICRM

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ABSTRACT. Cardiac resynchronization therapy (CRT) improves quality of life, exercise capacity, and cardiac function in a significant number of patients with heart failure (HF) and left bundle branch block. CRT also reduces HF hospitalizations and overall mortality. A substantial number of patients however do not have a favorable clinical response. Evaluation of CRT non-response has been challenging as the primary mechanism for CRT improvement remains elusive. In addition, reported CRT response rates have varied significantly and are highly dependent on the criteria used to define the response. Futhermore, a disconnection exists between applying the outcome data from large clinical trials to the ''real world'' expectations of daily clinical practice. The ultimate goals of CRT should both met the patients' expectations for symptomatic improvement and also improve cardiac function and/or outcomes.

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Impact of segmental left ventricle lead position on cardiac resynchronization therapy outcomes

Cited by 82 publications

References 26 publications

Evaluation of Coronary Venous Anatomy by Multislice Computed Tomography

Evaluation of Coronary Venous Anatomy by Multislice Computed Tomography

Long-term experience with coronary sinus side branch stenting to stabilize left ventricular electrode position

How to Define Cardiac Resynchronization Therapy Response

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