The Importance of Lead Positioning to Improve Clinical Outcomes in Cardiac Resynchronization Therapy

Stoia, Mirela-Anca; Istrătoaie, Sabina; Pop, S.; Anton, Florin Petru; Crişan, Sorin; Blendea, Dan

doi:10.5772/intechopen.85488

Cited by 2 publications

(1 citation statement)

References 47 publications

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“…По данным литературы и собственным наблюдениям, при имплантации левожелудочкового электрода достаточно часто встречаются анатоhttps://doi.org/10.17816/clinpract76720 мические трудности, такие как особенности коронарного синуса (5-10% случаев), сложное строение целевых вен (15-30%) [4]. Анатомические особенности вен сердца, затрудняющие имплантацию левожелудочкового электрода, включают чрезмерно малый или чрезмерно большой диаметр целевой вены, локальное сужение (стеноз) вены, в том числе из-за мышечного мостика, острый угол отхождения вены, выраженную извитость вены, рассыпной тип строения вен [5].…”

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A successful placement of the left ventricular lead for the cardiac resynchronization device using the orthodromic snare technique: clinical case

Dubrovin

Shugaev

2021

Journal of Clinical Practice

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Background: The main aim of Cardiac Resynchronization Therapy (CRT) is a positive response of the patient, particularly, reduction of the symptoms and improvement of the heart contractility, that can be reached in 5070% of patients. The possibility of appropriate positioning the left ventricular (LV) lead is of great importance for the response to CRT. Certain instruments and technical approaches are used for the placement of the LV lead. Here, we describe the use of the orthodromic snare technique, which is quite rare in practice, but allows one to overcome some anatomical obstacles. Clinical case description: Patient A., suffering from the heart failure with a low ejection fraction and left bundle branch block, was admitted to the hospital for CRT implantation. Before the operation, all the necessary routine instrumental and laboratory diagnostics was performed. During the operation, venography of the cardiac veins revealed unsuitability of the lateral cardiac vein for the placement of the LV lead due to its very small diameter. The posterolateral vein was suitable for the LV lead implantation but still had some anatomical difficulties: an acute angle of inflow and local stenosis in the proximal segment. During the procedure, the following techniques were used without success: positioning the LV lead by a simple translational movement forward, a subselective catheter, introduction of several coronary guides in order to smooth out the acute angle of inflow. These circumstances warranted the use of the orthodromic snare technique for a successful LV lead placement. Conclusion: This clinical case illustrates the possibility of a safe and effective use of the orthodromic snare technique for LV lead implantation. Such anatomical difficulties as a small diameter, acute angle of inflow, local stenosis have also been illustrated and discussed.

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A successful placement of the left ventricular lead for the cardiac resynchronization device using the orthodromic snare technique: clinical case

Dubrovin

Shugaev

2021

Journal of Clinical Practice

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Anatomical Features of the Cardiac Venous System, Significant for the Left Ventricular Lead Placement: Literature Review and Experience

Dubrovin

Мамчур

Shugaev

2023

Kompleks. probl. serdečno-sosud. zabol.

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HighlightsThe article is a comprehensive literature review on anatomical variations and anomalies of cardiac veins. A classification of coronary venous anatomy and anomalies detailing clinical, anatomical and radiological features is proposed. Developing such classification is important for the field of left ventricular lead placement, as it would cover a variety of clinically significant anomalies of cardiac veins. AbstractWith the advancements in the cardiac resynchronization therapy, the role of cardiac vein anatomy has become vital due to the complications associated with poor left ventricle lead placement. The cardiac vein anatomy varies much more than the anatomy of the coronary arteries, thus making cardiac veins much harder to study. In this article we have analyzed different approaches to description and naming of cardiac veins, and have summarized venous anomalies and features described in literature or encountered in real clinical practice. All anatomical features described in the article have a clinical significance in the left ventricle lead placement. Moreover, we have analyzed the wide variety of suggestions to overcoming anatomical obstacles. As a result of the analysis, we have proposed a clinical classification of the coronary venous anomalies and features that can be used during the implantation of cardiac resynchronization therapy devices.

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The Importance of Lead Positioning to Improve Clinical Outcomes in Cardiac Resynchronization Therapy

Cited by 2 publications

References 47 publications

A successful placement of the left ventricular lead for the cardiac resynchronization device using the orthodromic snare technique: clinical case

A successful placement of the left ventricular lead for the cardiac resynchronization device using the orthodromic snare technique: clinical case

Anatomical Features of the Cardiac Venous System, Significant for the Left Ventricular Lead Placement: Literature Review and Experience

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