What is the clinical evidence from this study?

Study design: Observational. Population: Failed transvenous coronary sinus lead placement for cardiac resynchronization therapy (n=9). Intervention: Endocardial left ventricular lead placement using a steerable introducer and active fixation lead. Primary outcome: Successful left ventricular lead placement.

What does this research mean for the field?

Targeted left ventricular endocardial pacing using a steerable introducer and active fixation lead is a feasible and safe alternative for patients with failed coronary sinus lead placement, achieving high success rates without acute complications or embolic events. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To evaluate the feasibility and safety of targeted left ventricular endocardial lead placement using a steerable introducer and active fixation lead following failed coronary sinus access.

December 26, 2008EP EuropaceOpen Access

Targeted left ventricular endocardial pacing using a steerable introducing guide catheter and active fixation pacing lead

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Key result

Targeted left ventricular endocardial pacing was successfully achieved in 8 of 9 patients with failed coronary sinus lead placement, with no acute complications or embolic events during follow-up.

Why the study?

Is targeted left ventricular endocardial pacing feasible and safe in patients with failed coronary sinus lead placement?

Population

9 patients (7 males, age 48-77 years) in whom transvenous coronary sinus lead placement had failed.

Design

Case_series

Follow-up

1-32 months

Authors

JMJames M. MorganUniversity of Kentucky PSPaul A. ScottKing's College London NTN. G. TurnerEssex Cardiothoracic Centre

Discussion

Member takes

Implication

Should not yet change CRT lead practice; leaves open need for prospective safety and efficacy trials.

Key Points

To evaluate the feasibility and safety of targeted left ventricular endocardial lead placement using a steerable introducer and active fixation lead following failed coronary sinus access.
Intervention attempted in N=9 patients (seven males, aged 48–77 years) with prior failed transvenous coronary sinus lead placement.
Procedures utilized femoral trans-septal puncture and dilatation, followed by advancing a steerable introducer from the subclavian vein to implant an active fixation polyurethane lead into the high postero-lateral left ventricular wall.
All patients were prescribed systemic anticoagulation following implantation and monitored over a follow-up period ranging from 1 to 32 months.
Successful left ventricular lead placement occurred in 8 of 9 patients (88.9%), with zero acute complications and no embolic events observed over 1–32 months of follow-up.
All successfully implanted patients achieved clinical benefit, demonstrating either an improvement in New York Heart Association functional class or sustained symptomatic gains previously provided by epicardial pacing.

Study Design

Type

Observational (n=9)

Structured PICO

Is targeted left ventricular endocardial pacing feasible and safe in patients with failed coronary sinus lead placement?

Population

9 patients (7 males, age 48-77 years) in whom transvenous coronary sinus lead placement had failed.

Intervention

Endocardial left ventricular lead placement using a steerable introducer catheter and active fixation polyurethane lead via trans-septal puncture, followed by anticoagulation.

Outcome

Feasibility of endocardial left ventricular pacing (successful lead placement)

Targeted left ventricular endocardial pacing is a feasible and potentially safe alternative for cardiac resynchronization therapy when standard coronary sinus lead placement fails.

Cite This Study

Morgan et al. (2008) conducted an observational in Failed transvenous coronary sinus lead placement for cardiac resynchronization therapy (n=9). Endocardial left ventricular lead placement using a steerable introducer and active fixation lead was evaluated on Successful left ventricular lead placement. Targeted left ventricular endocardial pacing was successfully achieved in 8 of 9 patients with failed coronary sinus lead placement, with no acute complications or embolic events during follow-up.

synapsesocial.com/papers/6a183995aeefdf6d9c13831d https://doi.org/10.1093/europace/eup048

Topics

Heart failure HFrEF treatment

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Targeted left ventricular endocardial pacing using a steerable introducing guide catheter and active fixation pacing lead

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Topics

Targeted left ventricular endocardial pacing using a steerable introducing guide catheter and active fixation pacing lead

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Cite This Study

Also Consider

Topics

Also Consider