Comparison of left ventricular lead placement via the coronary venous approach versus lateral thoracotomy in patients receiving cardiac resynchronization therapy
Section snippets
Study population
Between January 1997 and March 2002, 81 patients received a CRT system, including a lead for LV pacing. Twenty-five patients received LLT leads due to unavailability of CV leads (n = 24) or due to failure of the CV approach (n = 1). When transvenous leads became available in 1999, LV pacing was achieved in 56 patients by positioning a lead into a branch of the coronary sinus venous system. There were no significant differences between patients of both the LLT and CV groups (Table 1).
Implantation procedure
The LLT
CV group versus LLT group
Eighty-one patients received a CRT system. Patient characteristics according to implantation technique are listed in Table 1. CV lead implantation was successful in 56 of 57 patients (98%) in whom it was attempted. One patient developed a dissection of the coronary sinus without hemodynamic complications and received a LLT lead.
In 25 patients, LLT leads were implanted due to unavailability of CV leads (n = 24) or unsuccessful CV lead placement (n = 1). Implant durations were not significantly
Discussion
This study confirms that CV lead implantation is feasible with a success rate of about 98%, which correlates with the range of 81% to 99% reported in earlier studies.6, 7, 8, 9, 10, 11 Perioperative morbidity was low, and there was no procedure-related mortality, irrespective of the surgical approach for implanting the LV lead. The main advantage of the CV approach is that it is less invasive in this patient population, with a high perioperative risk due to advanced heart failure. This
References (18)
- et al.
Acute hemodynamic effects of biventricular DDD pacing in patients with end-stage heart failure
J Am Coll Cardiol
(1998) - et al.
Transvenous left ventricular lead implantation with the EASYTRAK lead systemthe European experience
Am J Cardiol
(2000) - et al.
Excercise performance following cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay
Am J Cardiol
(2002) - et al.
Long-term improvements in quality of life by biventricular pacing in patients with chronic heart failureresults from the Multisite Stimulation in Cardiomyopathy Study (MUSTIC)
Am J Cardiol
(2003) - et al.
Effect of pacing chamber and atrioventricular delay on acute systolic function of paced patients with congestive heart failure
Circulation
(1999) - et al.
Improved left ventricular mechanics from acute VDD pacing in patients with dilated cardiomyopathy and ventricular conduction delay
Circulation
(1999) - et al.
Evaluation of different ventricular pacing sites in patients with severe heart failureresults of an acute hemodynamic study
Circulation
(1997) - et al.
Multisite Stimulation in Cardiomyopathies (MUSTIC) Study Investigatorseffects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay
N Engl J Med
(2001) - et al.
Implantation techniques and chronic lead parameters of biventricular pacing dual-chamber defibrillators
J Cardiovasc Electrophysiol
(2002)