Left ventricular lead placement using inner guiding catheter alone in cardiac resynchronization therapy device implantation

Abstract

Background Subselection inner catheters (Inner‐Cath) are used adjunctively with outer guiding catheters (Outer‐Cath) during cardiac resynchronization therapy (CRT) device implantation. This study aims to investigate the feasibility and efficacy of left ventricular lead placement (LV‐LP) guided by Inner‐Cath alone. Methods A total of 74 patients undergoing de novo CRT implantation were investigated. LV‐LP was initially guided by Inner‐Cath in 42 patients (Inner‐Cath group) and Outer‐Cath in 32 patients (Outer‐Cath group). In the Inner‐Cath group, a 7Fr Inner‐Cath was advanced to the coronary sinus through a 7 Fr sheath inserted in a subclavian vein. In the Outer‐Cath group, 9Fr or 10Fr Outer‐Caths were used. Success rate of LV‐LP, additional use of inner or outer catheters and procedure‐related complications were compared between groups. Results LV‐LP was successful in all patients in the Inner‐Cath group, while LV‐LP had to be abandoned in two patients (6.3%) of the Outer‐Cath group due to CS perforation caused by Outer‐Cath manipulation. Procedure time was significantly shorter in the Inner‐Cath group (148 vs. 168 min; p = .024). Deployment of both an inner and outer cath became necessary less frequently for the Inner‐Cath group (4.8% vs. 56.3%; p < .001). Mechanical CS injuries due to guiding catheter manipulation were only observed in the Outer‐Cath group (0% vs. 15.6%, p = .013). Conclusion LV‐LP guided by Inner‐Cath alone was feasible in over 95% of the patients without severe complications. This methodology for LV‐LP may be preferable in CRT candidates with severe LV dysfunction in terms of shorter procedure time, smaller guiding sheath, and less procedure‐related complications.

A novel catheter ablation strategy for non‐paroxysmal atrial fibrillation combining cryoballoon, radiofrequency, and Marshall‐vein ethanol ablations

“…A 7Fr inner guiding catheter with 90°‐angled tip (Attain Select II SV (6248VI‐90S); Medtronic) was advanced to the CS trunk using a 5Fr EP‐catheter through a 7Fr short sheath placed in the right internal jugular vein 15 . Then, a CS venogram was performed by injecting contrast through the inner guiding catheter (Figure 4A).…”

“…EP-catheter through a 7Fr short sheath placed in the right internal jugular vein. 15 Then, a CS venogram was performed by injecting contrast through the inner guiding catheter (Figure 4A). If the VOM size on the CS venogram was suitable for EA-VOM, a 0.014-inch guidewire inserted within an over-the-wire balloon catheter (diameter: 1.25-2.5 mm, depending on the VOM size) was advanced to the VOM under fluoroscopy (Figure 4B).…”