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Technical Aspects of Implantation of LV Lead for Cardiac Resynchronization Therapy in Chronic Heart Failure
Author(s) -
KAUTZNER JOSEF,
RIEDLBAUCHOVÁ LUCIE,
C̆IHÁK ROBERT,
BYTEŠNÍK JAN,
VANC̆URA VLASTIMIL
Publication year - 2004
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/j.1540-8159.2004.00529.x
Subject(s) - medicine , coronary sinus , fluoroscopy , implant , lead (geology) , cardiac resynchronization therapy , stylet , cardiology , heart failure , surgery , ejection fraction , geomorphology , geology
The goal of this study was to analyze total procedural and fluoroscopic time during initial experience with implantation of LV lead in a single center, and to assess the performance of electrophysiologically‐guided approach for cannulation of the coronary sinus (CS) in a subsequent period. Over an initial period of 29 months, a total of 46 attempts to implant biventricular pacing system were revised. During the first phase, only one type of LV electrode was available for three implanters (11 attempts). The second phase covered their early experience with other stylet‐controlled LV leads (10 attempts). Additional LV leads including the over‐the‐wire design were available in the third phase and 25 attempts were done by he most experienced implanter. In a period of advanced experience, 92 implant procedures performed by four implanters using an electrophysiologically‐guided approach to CS cannulation were revised. In the first period, success rates for different phases reached 70%, 90%, and 96%, respectively. Significant decrease in both procedural and fluoroscopic times was achieved with increased experience (Phase I: 247.1 ± 104.5 minutes and 31.2 ± 34.3 minutes, Phase II: 219.4 ± 85.6 minutes, and 22.9 ± 19.1 minutes, Phase III: 116.4 ± 89.9 minutes and 6.6 ± 4.4 minutes, respectively, P < 0.05). Advanced experience with electrophysiologically‐guided approach to CS cannulation allowed achievement of this target within a reasonable amount of time (15.4 ± 16.3 minutes) and with minimum fluoroscopic time (2.1 ± 2.9 minutes). In conclusion, both individual learning curve and technical advances significantly influence success rate, procedural, and fluoroscopic times for biventricular system implantation. Electrophysiologically‐guided approach makes cannulation of the CS a highly reproducible procedure that requires minimum fluoroscopic time. (PACE 2004; 27[Pt. I]:783–790)