Long‐Term Follow‐Up of Biventricular Pacing Using a Totally Endocardial Approach in Patients with End‐Stage Cardiac Failure

Pasquié, Jean‐Luc; Massin, F.; Macia, Jean‐Christophe; Gervasoni, Richard; Bortone, Agustín; Cayla, Guillaume; Grolleau, R; Leclercq, F

doi:10.1111/j.1540-8159.2007.00599.x

Cited by 32 publications

(53 citation statements)

References 11 publications

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“…12,[20][21][22] Embolic events in atrial transseptal lead patients have been ascribed to subtherapeutic anticoagulation. 12,20,22,23 The lack of residual flow across the ventricular septum, combined with the absence of lead in the low-pressure left atrial chamber, where lead thrombi are more likely to form, may make lead thrombosis or paradoxical emboli less likely than with the atrial transseptal route.24 Despite this all LV endocardial pacing is limited by the presence of a lead in the systemic circulation and the resultant need for lifelong anticoagulation, unless new technologies can safely eliminate the risk of thrombus formation. The risk-benefit ratio of anticoagulation in patients with heart failure is finely balanced and may make this approach inappropriate in some patients.…”

mentioning

confidence: 99%

Development of a Technique for Left Ventricular Endocardial Pacing via Puncture of the Interventricular Septum

Betts

Gamble

Khiani

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Left ventricular (LV) pacing through the coronary sinus is the standard approach for cardiac resynchronization therapy. When this route is unavailable, the alternatives have major limitations. LV endocardial pacing through the interventriuclar septum may offer a simpler solution. We describe an initial case series to demonstrate technical feasibility and to describe our refinement of the puncture technique. Methods and Results-Ten patients with previous failed coronary sinus lead implant or with nonresponse to cardiac resynchronization therapy and a suboptimal LV lead position were selected. All patients were anticoagulated. Left ventriculography and coronary angiography were performed to identify LV borders and septal vessels. Subclavian vein access was used for a superior approach ventricular transseptal puncture under fluoroscopic guidance, using a steerable sheath and a standard transseptal needle, radiofrequency needle, or radiofrequency energy delivered through a guidewire. An active-fixation pacing lead was successfully delivered to the endocardial wall of the lateral LV in all patients (9 men; age, 62±10 years). LV lead implant procedure time shortened with experience. The use of radiofrequency energy delivered through a guidewire was the most effective technique. Mean threshold and R wave at implant were 0.8±0.3 V and 10.8±3.9 mV. At follow-up (mean, 8.7 months; minimum, 0; and maximum 19), thresholds were stable, and there were no thromboembolic events. Of 9 patients, 8 were classed as clinical responders (1 had inadequate follow-up to assess response). Conclusions-LV endocardial pacing through a ventricular septal puncture is a feasible approach for cardiac resynchronization therapy. (Circ Arrhythm Electrophysiol. 2014;7:17-22.)Key Words: cardiac resynchronization therapy ◼ endocardium ◼ heart ventricles ◼ septal Received September 11, 2013; accepted December 16, 2013. From the Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, United Kingdom (T.R.B., J.H.P.G., R.K., Y.B., K.R.); and Department of Cardiology, Milton Keynes Hospital NHS Foundation Trust, Milton Keynes, United Kingdom (R.K. Figure 1). Once a LV pressure trace was seen, a hand injection of contrast media was used to confirm that the needle was in the LV cavity. The dilator and sheath were then advanced 10 to 20 mm into the chamber over the needle. The needle was withdrawn and a 0.032-inch stiff 260-cm J guidewire was advanced through the sheath and dilator and curled in the LV cavity. The sheath and dilator were then advanced through the septum until the sheath tip was 1 to 2 cm inside the LV. The sheath and dilator were withdrawn and exchanged over the stiff guidewire for a slit-able, deflectable lead delivery catheter and dilator (Medtronic Attain or Select Secure; Medtronic, Minneapolis, MN). 2. Radiofrequency needle (cases 2 and 3): the procedure was performed using a stiff 98-cm radiofrequency transseptal needle (NRG; Bayliss Medical, Montreal, Canada). When opposed against the s...

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confidence: 99%

Development of a Technique for Left Ventricular Endocardial Pacing via Puncture of the Interventricular Septum

Betts

Gamble

Khiani

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…Long-term follow-up data of the thromboembolic complications in patients who had a transseptal endocardial LV lead implanted are scarce. So far no thromboembolic complications where reported as long as anticoagulant therapy was followed [13,[25][26][27]. During follow-up no thromboembolic events occurred in our study population.…”

Section: Discussionmentioning

confidence: 82%

Transseptal Leftventricular Endocardial Pacing is an Alternative Technique in Cardiac Resynchronization Therapy. One Year Experience in a High Volume Center

Neuhoff

Szilágyi

Molnár

et al. 2016

Romanian Journal of Internal Medicine

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Introduction. In patients receiving cardiac resynchronization therapy (CRT), failure rate to implant the left ventricular (LV) lead by the traditional trans-venous approach is 4-8%. Surgical epicardial implantation is considered as an alternative, but this technique is not without morbidity. Evidence from case documentation and from small trial batches demonstrated the viability of endocardial LV lead implantation where surgical epicardial lead placement is not applicable.Material and Methods. Four patients were implanted with endocardial LV lead using the transseptal atrial approach after unsuccessful transvenous implantation. Implantation of an endocardial active fixation LV leads was successful in all patients with stable electrical parameters immediately after implantation and over the follow-up period. All patients received anticoagulation therapy in order to target the international normalized ratio of 2.5-3.5 and have not experienced any thromboembolic, hemorrhagic events, or infection.Results. Follow-up echocardiography indicated significant improvement of LV systolic function (24 + 4.9 to 32 + 5.1 %, P = 0.023) with a notable improvement of the functional status.Conclusions. Endocardial left ventricular lead implantation can be a valuable and safe alternative technique to enable LV stimulation in high surgical risk patients where standard coronary sinus implant is unsuccessful.

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“…First, the transapical approach has the advantage that the LV lead is not crossing the mitral valve with the potential to cause dysfunction, which was, however, almost completely eliminated by using very flexible 4F leads. The risk of mitral valve endocarditis as mentioned by Kassaï et al, due to close and permanent contact between lead and the mitral valve, is not supported by the long-term follow-up of LV endocardial leads as reported by Pasquié et al (Kassaï et al, 2008;Kassaï et al, 2009;Pasquié et al, 2007). It will be clear that in the presence of an artificial mitral valve the transseptal approach is contra indicated.…”

Section: Wwwintechopencom Left Ventricular Endocardial Pacing Technmentioning

confidence: 89%

“…Anticoagulant therapy with a recommended target INR between 2.5 and 3.5 is mandatory in these patients, although the risk of thromboembolic complications seems to diminish 3 years after implantation, suggesting complete endotheliazation after this period (Sharifi et al, 1995). Long term follow-up showed no thrombo-embolic complications as long as anticoagulant therapy was maintained (Pasquié et al, 2007). In our series ninety percent (18 out of 20 patients) had already an indication for anticoagulant therapy before the decision for CRT, as is common in this patient population.…”

Section: Implantation Techniquementioning

confidence: 99%

Left Ventricular Endocardial Pacing Techniques as an Alternative for Ineffective Cardiac Resynchronization Therapy and the Role of Acute Hemodynamic Evaluation

Gelder¹,

Houthuizen²,

Scheffer³

et al. 2011

Modern Pacemakers - Present and Future

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Long‐Term Follow‐Up of Biventricular Pacing Using a Totally Endocardial Approach in Patients with End‐Stage Cardiac Failure

Abstract: Long-term endocardial biventricular stimulation via a transseptal approach was safe and effective in this small population. This approach needs to be further compared with conventional epicardial pacing via the coronary sinus.

Cited by 32 publications

References 11 publications

Development of a Technique for Left Ventricular Endocardial Pacing via Puncture of the Interventricular Septum

Development of a Technique for Left Ventricular Endocardial Pacing via Puncture of the Interventricular Septum

Transseptal Leftventricular Endocardial Pacing is an Alternative Technique in Cardiac Resynchronization Therapy. One Year Experience in a High Volume Center

Left Ventricular Endocardial Pacing Techniques as an Alternative for Ineffective Cardiac Resynchronization Therapy and the Role of Acute Hemodynamic Evaluation

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