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Coronary Sinus Side Branches for Cardiac Resynchronization Therapy: Prospective Evaluation of Availability, Implant Success, and Procedural Determinants
Author(s) -
DURAY GABOR Z.,
HOHNLOSER STEFAN H.,
ISRAEL CARSTEN W.
Publication year - 2008
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2007.01096.x
Subject(s) - medicine , cardiac resynchronization therapy , coronary sinus , implant , fluoroscopy , lead (geology) , cardiology , prosthesis implantation , surgery , heart failure , ejection fraction , prosthesis , geomorphology , geology
There are only sparse data concerning individual coronary side branch (CS‐SB) anatomy with respect to LV lead implantation for cardiac resynchronization therapy (CRT).Methods:In patients (pts) undergoing CRT device implantation, a detailed venogram was obtained, and the CS‐SB of first, second, third, and fourth choices for CS‐lead implantation was defined. Study endpoints included successful LV lead implantation in the first choice CS‐SB, number of CS‐SB potentially available, implantation success in selected CS‐SB, procedural variables, and 6‐month response to CRT.Results:CRT defibrillator implantation was attempted in 77 pts. Only 1 suitable CS‐SB was present in 3 (4%), 2 in 20 (26%), 3 in 36 (47%), and 4 CS‐SB in 18 patients (23%). The LV lead was implanted in the first choice CS‐SB in 71% of patients, in the second choice in 16%, in the third choice in 3%. In 4 patients (5%) no LV lead could be implanted. Implant success was similar for different CS‐SB regions (P = ns). Successful LV lead implantation in the CS‐SB of first choice was associated with median fluoroscopy and procedure times of 20 ± 13 and 143 ± 41 minutes. Corresponding times for the CS‐SB of ≥ second choice were 38 ± 21 (P = 0.002) and 179 ± 47 minutes (P = 0.002). Response rate at 6 months was 64% for patients with LV leads in the first target CS‐SB.Conclusions:In 70% of patients undergoing CRT device implantation, at least three suitable CS‐SBs are available. Implant success in the CS‐SB of first choice is 71% without significant differences for any particular CS‐SB region.