Strategy for Failed Transvenous Left-Ventricular Lead Placement in Cardiac Resynchronization Therapy: Surrender or Struggle?
| Autor: | Weizhu Ju, Cheng Cai, Minglong Chen, Weidong Gu, Bing Yang, Gang Yang, Yongfeng Shao, Zidun Wang, Buqing Ni, Mingfang Li, Fengxiang Zhang, Jiaojiao Shi, Hongwu Chen, Kai Gu, Yong-Mei Cha, Hailei Liu |
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| Rok vydání: | 2021 |
| Předmět: |
Heart Failure
medicine.medical_specialty Electroanatomic mapping Ejection fraction Ventricular lead business.industry Heart Ventricles medicine.medical_treatment Cardiac resynchronization therapy Cardiac Resynchronization Therapy QRS complex Treatment Outcome Concomitant Internal medicine Cardiology medicine Humans Female Pharmacology (medical) In patient Cardiac Resynchronization Therapy Devices Cardiology and Cardiovascular Medicine business Lead Placement |
| Zdroj: | Cardiology. 147:47-56 |
| ISSN: | 1421-9751 0008-6312 |
| Popis: | Introduction: For those cardiac resynchronization therapy (CRT) candidates who experience left-ventricular (LV) lead placement failure or underwent concomitant cardiac surgeries, surgical placement of epicardial LV lead guided by electroanatomic mapping may be a promising alternative. Methods: Electroanatomic mapping was used to guide positioning of the LV lead through a surgical approach. The LV lead was placed at the region with the latest local LV activation and normal voltage, away from the scar. Results: From April 2010 to September 2018, 10 consecutive patients (3 female) underwent surgical epicardial LV lead implantation. Among them, 3 had other surgical indications simultaneously (including 1 CRT non-responder), and 7 had failed transvenous LV lead placement. After CRT, the QRS duration was shortened from 149.3 ± 20.4 ms to 125.1 ± 15.2 ms (p = 0.01). At 6 months, the LV ejection fraction was significantly improved and remained stable in the follow-up (FU) period thereafter (baseline vs. 6 months, 31.0 ± 8.3% vs. 42.2 ± 13.4%, p = 0.006). Other parameters, including the threshold and impedance of the LV lead, were also stable at a mean FU of 755 ± 406 days, and the NYHA functional classification decreased from 2.9 ± 0.7 to 1.8 ± 0.8 (p = 0.002). Conclusions: Placement of an epicardial LV lead guided by electroanatomic mapping could be used as an adjunctive strategy in patients who were unable or refractory to conventional CRT therapy. This approach could also be applied in patients who had other surgical indications at the same time. |
| Databáze: | OpenAIRE |
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