Transseptal Leftventricular Endocardial Pacing is an Alternative Technique in Cardiac Resynchronization Therapy. One Year Experience in a High Volume Center

I. Neuhoff, S. Szilágyi, L. Molnár, I. Osztheimer, E. Zima, G. A. Dan, B. Merkely, L. Gellér

Research output: Contribution to journalArticle

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Abstract

INTRODUCTION: In patients receiving cardiac resynchronization therapy (CRT), failure rate to implant the left ventricular (LV) lead by the traditional trans-venous approach is 4-8%. Surgical epicardial implantation is considered as an alternative, but this technique is not without morbidity. Evidence from case documentation and from small trial batches demonstrated the viability of endocardial LV lead implantation where surgical epicardial lead placement is not applicable.

MATERIAL AND METHODS: Four patients were implanted with endocardial LV lead using the transseptal atrial approach after unsuccessful transvenous implantation. Implantation of an endocardial active fixation LV leads was successful in all patients with stable electrical parameters immediately after implantation and over the follow-up period. All patients received anticoagulation therapy in order to target the international normalized ratio of 2.5-3.5 and have not experienced any thromboembolic, hemorrhagic events, or infection.

RESULTS: Follow-up echocardiography indicated significant improvement of LV systolic function (24 + 4.9 to 32 + 5.1 %, P = 0.023) with a notable improvement of the functional status.

CONCLUSIONS: Endocardial left ventricular lead implantation can be a valuable and safe alternative technique to enable LV stimulation in high surgical risk patients where standard coronary sinus implant is unsuccessful.

Original languageEnglish
Pages (from-to)121-128
Number of pages8
JournalRomanian journal of internal medicine = Revue roumaine de médecine interne
Volume54
Issue number2
DOIs
Publication statusPublished - Apr 1 2016

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Cardiac Resynchronization Therapy
International Normalized Ratio
Coronary Sinus
Left Ventricular Function
Documentation
Echocardiography
Morbidity
Infection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Transseptal Leftventricular Endocardial Pacing is an Alternative Technique in Cardiac Resynchronization Therapy. One Year Experience in a High Volume Center. / Neuhoff, I.; Szilágyi, S.; Molnár, L.; Osztheimer, I.; Zima, E.; Dan, G. A.; Merkely, B.; Gellér, L.

In: Romanian journal of internal medicine = Revue roumaine de médecine interne, Vol. 54, No. 2, 01.04.2016, p. 121-128.

Research output: Contribution to journalArticle

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AU - Neuhoff, I.

AU - Szilágyi, S.

AU - Molnár, L.

AU - Osztheimer, I.

AU - Zima, E.

AU - Dan, G. A.

AU - Merkely, B.

AU - Gellér, L.

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AB - INTRODUCTION: In patients receiving cardiac resynchronization therapy (CRT), failure rate to implant the left ventricular (LV) lead by the traditional trans-venous approach is 4-8%. Surgical epicardial implantation is considered as an alternative, but this technique is not without morbidity. Evidence from case documentation and from small trial batches demonstrated the viability of endocardial LV lead implantation where surgical epicardial lead placement is not applicable.MATERIAL AND METHODS: Four patients were implanted with endocardial LV lead using the transseptal atrial approach after unsuccessful transvenous implantation. Implantation of an endocardial active fixation LV leads was successful in all patients with stable electrical parameters immediately after implantation and over the follow-up period. All patients received anticoagulation therapy in order to target the international normalized ratio of 2.5-3.5 and have not experienced any thromboembolic, hemorrhagic events, or infection.RESULTS: Follow-up echocardiography indicated significant improvement of LV systolic function (24 + 4.9 to 32 + 5.1 %, P = 0.023) with a notable improvement of the functional status.CONCLUSIONS: Endocardial left ventricular lead implantation can be a valuable and safe alternative technique to enable LV stimulation in high surgical risk patients where standard coronary sinus implant is unsuccessful.

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