Left ventricular endocardial pacing in the real world: Five years of experience at a single center

Abstract

Background A left ventricular (LV) endocardial lead implant to achieve cardiac resynchronization therapy (CRT) is feasible when a conventional implant failed due to anatomical or technical issues or when the venous implant was performed but the patient did not respond to the therapy. Methods Data about the implantation procedure (age, sex, clinical characteristics, anticoagulant use, and previous devices), patient characteristics (indication, technique used, lead model, complications), and follow‐up (clinical and echocardiographic outcome, LV lead electrical measurements) were analyzed for all CRT systems implanted using LV endocardial lead, due to failed conventional implant or nonresponse, between April 2011 and November 2016. Results Thirty‐five patients were implanted with an active fixation LV endocardial lead during the study period, without significant complications. There were no dislodgements or severe complications related to the implant procedure in the follow‐up period (36 ± 20 months) and a high percentage of patients responded to therapy, as assessed by several indicators. Conclusions An LV endocardial lead implant was feasible when the conventional technique had previously failed or was not effective. A high rate of response was achieved without any significant complications.

A systemic review of endocardial left ventricular pacing

“…This fact reinforces the role of this alternative approach for resynchronization as an efficient option, with potential to improve prognosis. Without this technique, patients would remain symptomatic with a rapid worsening of LVEF The successful resynchronization therapy also reduces the QRS width, 7,[10][11][12] in all the studies except one. Geller et al 2 did not found a significant difference in the QRS duration after the procedure, but the authors did not point out a possible explanation for this finding and QRS width was not the endpoint of the study.…”

Proarrhythmic effect of bipolar epicardial left ventricular stimulation in CRT resolved maintaining biventricular pacing with unipolar‐cathodical configuration: A peculiar case report

“…If this is not possible, alternative solutions should be considered such as endocardial LVp, which has been shown to be effective and without proarrhythmic effect. 3 , 18 , 19 …”

“…Therefore, in cases where BiVp shows an early proarrhythmic effect, it may be advisable to seek alternative programming that keeps the CRT active without inducing further VA: initial proarrhythmic effects of CRT may be solved by the long‐term antiarrhythmic effects of effective CRT. If this is not possible, alternative solutions should be considered such as endocardial LVp, which has been shown to be effective and without proarrhythmic effect 3,18,19 …”