Mid-term follow up of thromboembolic complications in left ventricular endocardial cardiac resynchronization therapy

Rademakers, Leonard M.; Gelder, Berry M. van; Scheffer, M; Bracke, Frank

doi:10.1016/j.hrthm.2014.01.031

Cited by 51 publications

(56 citation statements)

References 30 publications

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“…[117][118][119][120] Moreover, endocardial LV lead placement might increase the risk of mitral insufficiency, endocarditis, and systemic thromboembolism. 121 An alternative method for endocardial CRT is to use a left transapical approach via minimal thoracotomy. 122 Clearly, better and easier techniques, such as wireless pacing, 123 are required for endocardial CRT, after which randomized studies can be performed to investigate the benefits compared with conventional epicardial CRT.…”

Section: Endocardial LV Pacingmentioning

confidence: 99%

Strategies to improve cardiac resynchronization therapy

et al. 2014

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Cardiac resynchronization therapy (CRT) emerged 2 decades ago as a useful form of device therapy for heart failure associated with abnormal ventricular conduction, indicated by a wide QRS complex. In this Review, we present insights into how to achieve the greatest benefits with this pacemaker therapy. Outcomes from CRT can be improved by appropriate patient selection, careful positioning of right and left ventricular pacing electrodes, and optimal timing of electrode stimulation. Left bundle branch block (LBBB), which can be detected on an electrocardiogram, is the predominant substrate for CRT, and patients with this conduction abnormality yield the most benefit. However, other features, such as QRS morphology, mechanical dyssynchrony, myocardial scarring, and the aetiology of heart failure, might also determine the benefit of CRT. No single left ventricular pacing site suits all patients, but a late-activated site, during either the intrinsic LBBB rhythm or right ventricular pacing, should be selected. Positioning the lead inside a scarred region substantially impairs outcomes. Optimization of stimulation intervals improves cardiac pump function in the short term, but CRT procedures must become easier and more reliable, perhaps with the use of electrocardiographic measures, to improve long-term outcomes.

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Section: Endocardial LV Pacingmentioning

confidence: 99%

Strategies to improve cardiac resynchronization therapy

et al. 2014

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“…In a series of 51 patients who were implanted with a standard LV endocardial pacing lead using a transseptal approach, 14 % (n=7) suffered a thromboembolic event (stroke or TIA) during follow-up. While most of these patients had subtherapeutic anticoagulation at the time of the event (the goal INR was 3.5-4.5), and this risk would certainly be expected to be less with the smaller volume leadless electrodes associated with the multi-component systems [30].…”

Section: Limitations Of Leadless Cardiac Pacingmentioning

confidence: 99%

Leadless Cardiac Pacemakers: Pacing Paradigm Change

Neužil

Reddy

2015

Curr Cardiol Rep

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Traditional transvenous approach for permanent cardiac pacing can be associated with significant acute and chronic complications related partly to either the insertion of transvenous lead or subcutaneous placement of pacemaker device. We summarize the current status of a novel self-contained leadless cardiac pacemaker in the first-in-human and subsequent series of feasibility studies in patients indicated for ventricular rate-responsive pacing (VVI). Using a femoral venous approach, the device is implanted at the right ventricular apical septum region. We describe the technical and clinical characterization of this innovative technology. Two different systems of leadless pacemakers are currently implanted to the patients. Up to now, the electrical parameters, such as pacing thresholds, sensing parameters, and pacing impedances, either improved or remained stable within the accepted range. In this chapter, we also discuss the potential benefit for the future, but in summary, all available data demonstrate the feasibility of leadless cardiac pacing.

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“…Although once thought to be too risky given the possibility of thromboembolic complications, 7 alternative pacing strategies are being sought for heart failure patients who do not respond to more standard cardiac resynchronization strategies. Studies have described the technical feasibility of placing transvenous leads via an atrial transseptal puncture, 8 as well as a relatively acceptable thromboembolic risk: a study by Rademakers et al 9 noted a thromboembolic rate of 6.1 events per 100 patient-years, with all of the affected patients having subtherapeutic anticoagulation at the time of their event.…”

Section: Discussionmentioning

confidence: 99%