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

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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.

1. ABRAHAM WT, FISHER WG, SMITH AL, DELURGIO DB, LEON AR, LOH E et al. Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002; 346:1845-53.

2. CAZEAU S, LECLERCQ C, LAVERGNE T, WALKER S, VARMA C, LINDE C et al. Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay. N Engl J Med. 2001; 344:873-80.

3. CLELAND JGF, DAUBERT J-C, ERDMANN E, FREEMANTLE N, GRAS D, KAPPENBERGER L et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med. 2005; 352:1539-49.

4. BRISTOW MR, SAXON LA, BOEHMERJ, KRUEGER S, KASSDA, DE MARCO T et al. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350:2140-50.

5. GRAS D, BOCKER D, LUNATI M, WELLENSHJ, CALVERT M, FREEMANTLE N et al. Implantation of cardiac resynchronization therapy systems in the CARE-HF trial: procedural success rate and safety. Europace 2007; 9:516-22.

6. MEISEL E, PFEIFFER D, ENGELMANN L, TEBBENJOHANNSJ, SCHUERT B, HAHN S et al. Investigation of coronary venous anatomy by retrograde venography in patients with malignant ventricular tachycardia. Circulation 2001; 104:442-7.

7. HIGGINS SL, HUMMEL JD, NIAZIIK, GIUDICI MC, WORLEY SJ, SAXON LA et al. Cardiac resynchronization therapy for the treatment of heart failure in patients with intra-ventricular conduction delay and malignant ventricular tachyarrhythmias. J Am Coll Cardiol 2003; 42:1454-9.

8. LEÓN AR, ABRAHAM WT, CURTIS AB, DAUBERT JP, FISHER WG, GURLEY J et al. Safety of transvenous cardiac resynchronization system implantation in patients with chronic heart failure: combined results of over 2000 patients from a multicenter study program. J Am Coll Cardiol. 2005; 46:2348-56.

9. MAIR H, JANSENSJL, LATTOUF OM, REICHART B, DABRITZS. Epicardial lead implantation techniques for biventricular pacing via left lateral mini-thoracotomy, video-assisted thoracoscopy, and robotic approach. Heart Surg Forum 2003; 6:412-7.

10. GABOR S, PRENNER G, WASLER A, SCHWEIGER M, TSCHELIESSNIGGKH, SMOLLE -JUTTNERFM. A simplified technique for implantation of left ventricular epicardial leads for biventricular re-synchronization using video-assisted thoracoscopy (VATS). Eur J Cardiothorac Surg 2005; 28:797-800.

11. KOOS R, SINHA AM, MARKUS K, BREITHARDT OA, MISCHKE K, ZARSEM et al. Comparison of left ventricular lead placement via the coronary venous approach versus lateral thoracotomy in patients receiving cardiac resynchronization therapy. Am J Cardiol 2004; 94:59-63.

12. JAÏS P, DOUARD H, SHAH DC, BAROLD S, BARAT JL, CLÉMENTY J. Endocardial biventricular pacing. Pacing ClinElectrophysiol 1998; 21: 2128-31.

13. JAÏS P, TAKAHASHI A, GARRIGUE S, YAMANE T, HOCINI M, SHAH DC et al. Mid-term follow-up of endocardial biventricular pacing. Pacing ClinElectrophysiol 2000; 23: 1744-7.

14. LECLERCQ F, HAGER FX, MACIA JC, MARIOTTINI CJ, PASQUIÉ JL, GROLLEAU R. Left ventricular lead insertion using a modified transseptal catheterization technique: a totally endocardial approach for permanent biventricular pacing in end-stage heart failure. Pacing Clin Electrophysiol 1999; 22:1570-5.

15. VAN GELDER BM, SCHEFFER MG, MEIJER A, BRACKE FA. Transseptal endocardial left ventricular pacing: an alternative technique for coronary sinus lead placement in cardiac resynchronization therapy. Heart Rhythm 2007; 4:454-60.

16. NUTA B, LINES I, MACINTYRE I, HAYWOOD GA. Biventricular ICD implant using endocardial LV lead placement from the left subclavian vein approach and transseptal puncture via the transfemoral route. Europace 2007;9:1038-40.

17. MORGAN JM, SCOTT PA, TURNER NG, YUE AM, ROBERTS PR. Targeted left ventricular endocardial pacing using a steerable introducing guide catheter and active fixation pacing lead. Europace 2009; 11:502-6.

18. JI S, CESARIO DA, SWERDLOW CD, SHIVKUMAR K. Left ventricular endocardial lead placement using a modified transseptal approach. J Cardiovasc Electrophysiol 2004; 15:234-66.

19. FISH JM, DI DIEGO JM, NESTERENKO V, ANTZELEVITCH C. Epicardial activation of left ventricular wall prolongs QT interval and transmural dispersion of repolarization: implications for biventricular pacing. Circulation 2004; 109:2136-42.

20. FISH JM, BRUGADA J, ANTZELEVITCH C. Potential proar rhythmic effects of biventricular pacing. J Am CollCardiol 2005; 46:2340-47.

21. GARRIGUE S, JAIS P, ESPIL G, LABEQUEJN, HOCINI M, SHAH DC et al. Comparison of chronic biventricular pacing between epicardial and endocardial left ventricular stimulation using Doppler tissue imaging in patients with heart failure. Am J Cardiol 2001; 88:858-62.

22. JAISPSF, LABORDERIE J, REUTER S, BORDACHAR P, HSU LF, SANDERS P et al. Tailored endocardial left ventricular pacing is superior to coronary sinus in heart failure patients needing cardiac resynchronization. Heart Rhythm 2006; 3:S247.

23. VAN GELDER BM, BRACKE FA, OTO A, YILDIRIR A, HAAS PC, SEGERJ J et al. Diagnosis and management of inadvertently placed pacing and ICD leads in the left ventricle: a multicenter experience and review of the literature. Pacing Clin Electrophysiol. 2000; 23:877-83.

24. SHARIFI M, SORKIN R, SHARIFI V, LAKIER JB. Inadvertent malposition of a transvenous-inserted pacing lead in the left ventricular chamber. Am J Cardiol 1995; 76:92-95.

25. BRACKE FA, HOUTHUIZEN P, RAHEL BM, VAN GELDER BM. Left ventricular endocardial pacing improves the clinical efficacy in a non-responder to cardiac resynchronization therapy: role of acute haemodynamic testing. Europace. 2010; 12:1032–4.

26. PASQUIEJL, MASSIN F, MACIAJC, GERVASONI R, BORTONE A, CAYLA G et al. Long-term follow-up of biventricular pacing using a totally endocardial approach in patients with end-stage cardiac failure. Pacing Clin Electrophysiol. 2007; 30Suppl 1:S31-3.

27. BORDACHAR P, DERVAL N, PLOUX S, GARRIGUE S, RITTER P, HAISSAGUERRE M, et al. Left ventricular endocardial stimulation for severe heart failure. J Am Coll Cardiol 2010; 56:747-753.

28. KUTYIFA V, MERKELY B, SZILAGYI S, ZIMA E, ROKA A, KIRALY A, OSZTHEIMERI, et al. Usefulness of electroanatomical mapping during transseptal endocardial left ventricular lead implantation. Europace 2012; 14:599-604.

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