TY - JOUR
T1 - Strategy for Failed Transvenous Left-Ventricular Lead Placement in Cardiac Resynchronization Therapy
T2 - Surrender or Struggle?
AU - Gu, Kai
AU - Cai, Cheng
AU - Ni, Buqing
AU - Gu, Weidong
AU - Liu, Hailei
AU - Wang, Zidun
AU - Yang, Bing
AU - Zhang, Fengxiang
AU - Ju, Weizhu
AU - Chen, Hongwu
AU - Yang, Gang
AU - Li, Mingfang
AU - Shi, Jiaojiao
AU - Shao, Yongfeng
AU - Cha, Yong Mei
AU - Chen, Minglong
N1 - Publisher Copyright:
© 2021 S. Karger AG, Basel
PY - 2022/1/1
Y1 - 2022/1/1
N2 - 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.
AB - 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.
KW - Cardiac resynchronization therapy
KW - Electroanatomic mapping
KW - Left-ventricular lead
KW - Surgery
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U2 - 10.1159/000519904
DO - 10.1159/000519904
M3 - Article
C2 - 34844237
AN - SCOPUS:85120621820
SN - 0008-6312
VL - 147
SP - 47
EP - 56
JO - Cardiology
JF - Cardiology
IS - 1
ER -