Minimalistic strategy for coronary sinus lead implant: A single tool capable of electrophysiological mapping, pressure measurement, and angiography

Autor:	Kumaraswamy Nanthakumar, Ben Ng, Andrew C.T. Ha, Abhishek Bhaskaran, Mahmoud M. Bokhari, Rahul Samanta, Krishnakumar Nair
Rok vydání:	2020
Předmět:	Male Cardiac Catheterization medicine.medical_specialty medicine.medical_treatment Cardiac resynchronization therapy Intracardiac pressure 030204 cardiovascular system & hematology Coronary Angiography Proof of Concept Study Cardiac Resynchronization Therapy 03 medical and health sciences 0302 clinical medicine Angioplasty Internal medicine medicine Humans Lead Dislodgement Cardiac Resynchronization Therapy Devices 030212 general & internal medicine Lead (electronics) Coronary sinus Aged Aged 80 and over Heart Failure medicine.diagnostic_test business.industry Coronary Sinus Equipment Design General Medicine Middle Aged Electrodes Implanted Catheter Angiography Cardiology Female Radiography Thoracic Cardiac Electrophysiology Cardiology and Cardiovascular Medicine business
Zdroj:	Pacing and Clinical Electrophysiology. 43:1072-1077
ISSN:	1540-8159 0147-8389
DOI:	10.1111/pace.14005
Popis:	Background Left ventricular (LV) lead implantation for cardiac resynchronization therapy (CRT) may be confounded by contrast load during attempted cannulation and lead dislodgement during guiding catheter splitting. An LV lead implant system with a steerable single catheter that completely avoids the use of guiding catheters when needed, acquires atrioventricular electrograms, measures intracardiac pressures, permits CS angiography, and has the ability to direct a coronary angioplasty wire that will lead the final delivery of LV lead into a CS tributary, may help limit contrast use and avoid lead dislodgement at CS guide sheath removal. Methods and results In this article as a proof of concept, we describe the use of this minimalist technique as a first line approach in six patients who had standard indications for CRT. The LV lead was successfully implanted in a target vein in all patients without acute complications. Contrast was not used in half the group and the LV lead was successfully implanted without guiding catheter in four patients. The implantation technique evolved through the series and in the final patient, no guiding sheath or contrast was used. Postimplant lead positions on chest X-ray and lead parameters were stable in all patients at follow-up. Conclusion In proof of concept paper, we describe a technique of LV lead implantation potentially without the use of contrast and standard CS guiding catheters. Once familiar, this approach may provide a less complicated strategy.
Databáze:	OpenAIRE
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