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Direct Left Ventricular Endocardial Pacing: An Alternative When Traditional Resynchronization Via Coronary Sinus Is Not Feasible or Effective
Author(s) -
MORIÑAVÁZQUEZ PABLO,
ROAGARRIDO JESSICA,
FERNÁNDEZGÓMEZ JUAN M.,
VENEGASGAMERO JOSÉ,
PICHARDO RAFAEL B.,
CARRANZA MANUEL H.
Publication year - 2013
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/pace.12125
Subject(s) - medicine , cardiac resynchronization therapy , coronary sinus , cardiology , left bundle branch block , ejection fraction , heart failure , ventricle , endocardium , lead (geology) , surgery , geomorphology , geology
Background Biventricular pacing through the coronary sinus (CS) is effective for the treatment of patients with heart failure and left bundle‐branch block. However, this approach is not always feasible. Although surgical epicardial lead implantation is an alternative, the technique may be deleterious in some patients. Thus, direct left ventricular (LV) endocardial pacing under local anesthesia may be an option. Objective We describe our technique and analyze the results of direct LV endocardial pacing. Method Fourteen patients with failed resynchronization via CS (April 2006–September 2011) were selected. Using a femoral approach, we performed transseptal puncture and LV mapping, then fixed the active lead where the longest electrical delay was observed; the generator was placed in the anterior thigh. For resynchronization, eight patients with a device previously implanted through the upper veins received a single‐chamber generator that was set to the VVT mode to sense the subclavian pacing spike. Six patients received a complete femoral resynchronization system with either a defibrillator or pacemaker. Patients were followed for 6–54 months. Results The LV lead was successfully implanted in all cases. Two patients experienced excessive bleeding and two died during follow‐up. All except one improved at least one New York Heart Association class and experienced improved left ventricle ejection fraction. One patient with recurrent episodes of ventricular fibrillation was asymptomatic. Conclusion Direct LV endocardial pacing is safe and may be a less risky, more efficient alternative than surgical epicardial lead implantation for resynchronization via CS.