Key result
Left ventricular lead implantation was successful in 92% of patients, though 30% were implanted outside the initial target vein and 32% at the anterior or anterolateral wall.
Observational (n=90)
Despite recommendations for lateral or posterolateral placement, nearly one-third of left ventricular leads in CRT are implanted at the anterior or anterolateral wall.
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Real-world CRT often places LV leads outside recommended sites; leaves open impact on outcomes and need for targeted strategies.
BACKGROUND: Cardiac resynchronization therapy (CRT) is a recognized treatment for severe heart failure. The recommended left ventricular (LV) lead position is at the lateral or posterolateral wall. However, LV leads cannot always be implanted at the expected site. The aim of our study was to describe in a large series of patients the anatomical position really achieved by LV leads at implant. METHOD: In consecutive patients referred for CRT, we determined the LV lead implantation success rate, the success rate for the initial target vein, and the final position achieved by the tip of the LV lead in the left and right anterior oblique projections. RESULTS: Ninety patients (66 men, 71 +/- 9 years, 20% New York Heart Association (NYHA) class IV) were referred for an LV lead implantation between September 2003 and March 2006. A LV lead could be implanted in 92% of patients. In 70%, LV leads were implanted in the initial target vein. The final location was lateral or posterolateral in 68% and anterior or anterolateral in 32% of patients. The mean procedural time was 117 +/- 42 minutes. CONCLUSIONS: LV lead implantation was achieved in 92% of patients with mean procedure duration of less than 2 hours. Nevertheless, 30% of LV leads were implanted outside of the initial target vein and 32% at the anterior or anterolateral wall. Further studies are warranted to compare the responder rate to CRT when the LV lead is at the lateral or posterolateral wall or when the LV lead is at an alternative site.
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d'Ivernois et al. (2008) conducted an observational in Severe heart failure (n=90). Left ventricular lead implantation was evaluated on Left ventricular lead implantation success rate. Left ventricular lead implantation was successful in 92% of patients, though 30% were implanted outside the initial target vein and 32% at the anterior or anterolateral wall.
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