Key result
Nonthoracotomy coronary sinus lead implantation was feasible with an 89% overall success rate, showing no significant difference between over-the-wire (93%) and shaped (81%) leads (P=0.1).
Why the study?
Does nonthoracotomy coronary sinus lead implantation provide successful biventricular pacing with acceptable lead parameters and safety compared to thoracotomy in patients with heart failure and prolonged QRS?
Observational (n=87)
Does nonthoracotomy coronary sinus lead implantation provide successful biventricular pacing with acceptable lead parameters and safety compared to thoracotomy in patients with heart failure and prolonged QRS?
Absolute Event Rate: 93% vs 81%
p-value: p=0.1
Nonthoracotomy coronary sinus lead implantation for biventricular ICDs is feasible with a high success rate, though over-the-wire leads may offer better stability than shaped leads.
Supports feasibility of nonthoracotomy coronary sinus leads for biventricular pacing; leaves open randomized comparisons with thoracotomy.
INTRODUCTION: The aim of this study is to describe implantation techniques and lead performance for biventricular pacing, dual-chamber implantable cardioverter defibrillators (ICDs). METHODS AND RESULTS: A dual-chamber ICD with biventricular pacing was implanted in 87 patients with congestive heart failure (ejection fraction: 0.21 +/- 0.09), prolonged QRS duration (161 +/- 22 msec), and an indication for ICD therapy. Left ventricular pacing was achieved with a thoracotomy approach (n = 21) or a nonthoracotomy approach (n = 66). With a thoracotomy, biventricular devices were implanted successfully in all patients. During follow-up (17 +/- 11 months), 9 patients died (43%), 2 underwent transplantation, and 2 required left ventricular lead revision. At last follow-up, biventricular sensing and capture threshold were 11 +/- 5 mV and 1.5 +/- 0.8 V, respectively. For nonthoracotomy procedures, two types of coronary sinus (CS) leads were implanted: an over-the-wire lead (n = 45) and a shaped lead (n = 21). The rate of successful implantation (overall: 89%) (over-the-wire 93% vs shaped 81%; P = 0.1) and durations for CS lead placement (66 +/- 50 vs 58 +/- 34 min, P = 0.6) and the procedure (133 +/- 58 vs 129 +/- 33 min, P = 0.8) were not different between the two CS leads. During follow-up (11 +/- 9 months), 9 patients died (14%), and the shaped CS lead dislodged in 3 patients (3 shaped vs 0 over-the-wire, P = 0.01). At last follow-up, biventricular sensing and capture threshold were 10 +/- 4 mV and 1.8 +/- 0.7 V, respectively, and there was no difference between over-the-wire and shaped leads. By multivariate analysis, mortality was associated with absence of spironolactone therapy but not procedural features. CONCLUSION: Nonthoracotomy CS lead implantation is feasible, with a success rate of about 90% and few adverse events. For the remaining 10%, a thoracotomy approach can be completed safely in these ill patients without increased risk for death.
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Daoud et al. (2002) conducted an observational in Congestive heart failure (n=87). Over-the-wire coronary sinus lead vs. Shaped coronary sinus lead was evaluated on Successful implantation rate (p=0.1). Nonthoracotomy coronary sinus lead implantation was feasible with an 89% overall success rate, showing no significant difference between over-the-wire (93%) and shaped (81%) leads (P=0.1).
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