AI Article Synopsis
- Optimal placement of left ventricular (LV) leads during cardiac resynchronization therapy (CRT) can enhance patient outcomes, but can be affected by difficult venous anatomy.
- This study aimed to evaluate the safety and effectiveness of percutaneous coronary venoplasty (PCV) during CRT implantation and compare medium-term results with patients who did not require PCV.
- Out of 422 CRT recipients, 29 needed PCV, achieving a 72% success rate without complications, and showed no significant differences in long-term lead performance or survival compared to the control group, suggesting PCV is a beneficial technique for optimal LV lead positioning.
Article Abstract
Background: Optimal left ventricular (LV) lead placement improves response to cardiac resynchronization therapy (CRT) but can be hindered by unfavorable venous anatomy. Interventional procedures in the coronary veins have been described with promising short-term outcomes.
Objective: The purpose of this study was to establish the safety and efficacy of percutaneous coronary venoplasty (PCV) during CRT implantation and assess medium-term lead performances and clinical outcomes against matched controls not requiring PCV.
Methods: Each consecutive PCV case was matched according to age, gender, and bundle branch morphology to 2 controls from a large prospective registry of CRT recipients. Demographics, procedural success, lead performance, and response to CRT were tracked using a comprehensive electronic medical records system.
Results: Of 422 consecutive CRT recipients treated between 2012 to 2018, 29 patients (6.9%; mean age 65.7 ± 10.7 years; 7 female; 17 ischemic cardiomyopathy; 22 left bundle branch block) required PCV, which was successful in 21 cases (72%). Target veins measuring 1.1 ± 0.6 mm were dilated by noncompliant balloons with mean diameter 2.8 ± 0.5 mm. No complications occurred. Fluoroscopic and procedural durations were longer in the PCV group (P <.01) Over mean follow-up of 33.0 ± 25.0 months, no differences in lead performance, CRT response, or 2-year survival were observed compared to the control group.
Conclusion: PCV during CRT device implant is typically successful, safe and associated with long-term clinical outcomes comparable to patients who did not need PCV. This is an important technique to optimize LV lead placement and maximize CRT response.
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| http://dx.doi.org/10.1016/j.hrthm.2019.12.012 | DOI Listing |
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