Long-term single-centre large volume experience with transseptal endocardial left ventricular lead implantation

Abstract

Aims The aim of our study was to investigate the long-term efficacy and safety of transseptal endocardial left ventricular lead implantation (TELVLI). Methods and results Transseptal endocardial left ventricular lead implantation was performed in 54 patients (44 men, median age 69, New York Heart Association III–IV stage) between 2007 and 2017 in a single centre. In 36 cases, the transseptal puncture (TP) was performed via the femoral vein, and in 18 cases, the TP and also the left ventricular (LV) lead placement were performed via the subclavian vein. An electrophysiological deflectable catheter was used to reach the LV wall through the dilated TP hole. The LV lead implantation was successful in all patients. A total of 54 patients were followed up for a median of 29 months [interquartile range (IQR) 8–40 months], the maximum follow-up time was 94 months. Significant improvement in the LV ejection fraction was observed at the 3-month visit, from the median of 27% (IQR 25–34%) to 33% (IQR 32–44%), P < 0.05. Early lead dislocation was observed in three cases (5%), reposition was performed using the original puncture site in all. The patients were maintained on anticoagulation therapy with a target international normalized ratio between 2.5 and 3.5. Four thromboembolic events were noticed during follow-up. A total of 27 patients died, with a median survival of 15 months (IQR 6–40). Conclusion The TELVLI is an effective approach for cardiac resynchronization therapy (CRT) however it is associated with a substantial thromboembolic risk (7%).

Leadless left ventricular stimulation with WiSE-CRT System – Initial experience and results from phase I of SOLVE-CRT Study (nonrandomized, roll-in phase)

“…Most studies demonstrated significant improvements in LV remodeling and favorable clinical response to CRT; however, its procedural complexity and substantial long-term thromboembolic risk limit wider adoption. [16][17][18][19] The ALSYNC (Alternate Site Cardiac Resynchronization) was the first multicenter trial of LV endocardial transvenous lead pacing (superior transvenous atrial transseptal approach), which enrolled 138 patients who either had a failed transvenous CS lead or had nonresponse to CRT. 20 The procedure was successful in 118 of the 132 attempted cases (89%).…”

Novel Doppler‐guided subxyphoid approach to avoid coronary artery damage during left ventricular epicardial lead placement or ablation

“…His Bundle pacing 12 has proven useful in selected patients. Intravascular techniques in which a lead is directed trans‐septally to the left atrium and then through the mitral valve to the left ventricular endocardium (eg, ALSYNC protocol) 13 require continuous anticoagulation during follow‐up, but thrombo‐embolic events have been fairly common, 13,14 which may limit widespread acceptance of the method. Alternative methods for epicardial pacing are more invasive and include surgical approaches by thoracoscopy and various forms of mini‐thoracotomy 1‐3 .…”

Alternative Techniques of Left Ventricle Lead Implantation for Cardiac Resynchronization Therapy

“…При оценке рисков вмешательства с имплантацией ЛЖ электрода через МПП учитывается возможность травматизации створок митрального клапана. Однако, данных за подтверждение данной патологии исследователи не приводят, и даже наоборот, имеются результаты обследований, где уровень митральной регургитации снижается [31]. С использованием методики по имплантации ЛЖ электрода через МЖП имеются риски развития транссептальных токов крови в месте пункции и желудочковых тахикардий, что также в проведённых исследованиях не было подтверждено.…”

“…В публикации T.R.Betts et al 2018 года описывается развитие лакунарного ишемического инсульта и ТИА у 3-х из 15-ти пациентов за период от 6 недель до 3-х лет после оперативного вмешательства [19]. Также, в недавно опуб ликованном исследовании L.Gellér et al 2019 года описывается развитие тромбоэмболических осложнений у 4-х из 54-х пациентов (7%) на фоне терапии антагонистами витамина К, однако, при обследовании выяснилось, что уровень МНО у всех пациентов был ниже целевого (2,5) [31].…”