Background: Implantation of a left ventricular (LV) lead for cardiac resynchronisation therapy (CRT) may be challenging. Wider use of various implantation techniques increases the success rate of CRT.
Aim: Short-term analysis of the success rate of transvenous LV lead implantation for CRT.
Methods: All CRT procedures performed in 2009 with first-time LV lead implantation attempt were analysed in terms of efficacy, total number of procedures, procedure and fluoroscopy time, complications, and reinterventions. Final LV lead location and the number of tested sites were analysed. Complex procedures were defined and described.
Results: We studied 122 patients aged 67.6 ± 10.6 years (98 males/80%) selected for CRT. The CRT implantation was an upgrade procedure in 17 patients. Fifty-six (46%) patients had coronary artery disease and 111 (91%) patients were in NYHA class III. The mean LV ejection fraction was 27% (range 10-35%). The implantation success rate was 97.5%. There were 87 (73%) CRT-D systems implanted and 32 (27%) CRT-P systems. Mean procedure time was 118 ± 41 min, and fluoroscopy time was 15.9 ± 12.1 min. An optimal location of the LV lead was achieved in 107 (90%) patients. More than one LV lead sites were tested in 42 (35.3%) patients. Complex procedures were performed in 4 (3.4%) patients. Early LV lead reintervention (< 30 days) was necessary in 10 (8.4%) patients (11 procedures), and epicardial lead placement was performed in one patient. The LV lead location in the antero-lateral branch demonstrated the lowest reintervention rate (1/22, 4.5%) v. other sites (great cardiac vein: 1/8, 12.5%, lateral branches: 9/86, 10.5%, p = NS). The LV lead-related reinterventions and initial procedure failure were associated with the upgrade procedures. No serious periprocedural complications were recorded. In one patient, the CRT system was explanted due to pocket infection. One patent died three months after CRT implantation due to progressive end-stage congestive heart failure.
Conclusions: 1. In a tertiary centre, CRT implantation success rate is high and implantation procedures are safe. 2. Achieved LV lead location is optimal in a vast majority of patients. 3. We noted a significant rate of early reinterventions related to LV lead dislodgement. 4. The LV lead implantation failure and reinterventions occurred more frequently in subjects with upgrade- to-CRT procedures. A similar trend was also noted in patients after cardiac surgery. 5. In selected cases, advanced techniques must be used to achieve successful CRT implantation.
Kardiol Pol 2010; 68, 8: 903-909