Key result
Coronary venoplasty enables 100% successful LV lead implantation in severe vein stenosis without procedural complications.
Why the study?
Does coronary venoplasty allow successful left ventricular lead implantation in patients with target vein stenosis?
Observational (n=208)
No
Does coronary venoplasty allow successful left ventricular lead implantation in patients with target vein stenosis?
Coronary venoplasty is a feasible and effective technique to overcome target vein stenosis and facilitate successful left ventricular lead implantation during cardiac resynchronization therapy.
May support venoplasty for LV lead placement in select CRT cases with vein stenosis; leaves open need for larger prospective validation.
BACKGROUND: Optimal target vein selection for the pacing lead results in a better outcome, but left ventricular (LV) variability limits this selection. The aim of the present study was to investigate the efficacy of coronary venoplasty for insertion of a LV lead. METHODS AND RESULTS: Transvenous LV lead placement was attempted in 208 consecutive patients from November 2002 to January 2007, with success in 206 patients (99%). Retrospective analysis of the cardiac resynchronization therapy system implantation showed that 4 of the 206 patients (1.9%) required coronary venoplasty for insertion of the pacing lead implant. Using coronary balloon angioplasty catheters of 2.5 mm (2 patients), 3.0 mm (1 patient) and 4.0 mm (1 patient), each target vein was dilated. Of 4 patients, stenoses in 3 were dilated by balloon angioplasty only. However, focal stenosis of 1 patient was not able to be dilated due to severe stenosis. Therefore, part of the lesion was sharpened by rotational atherectomy and the stenosis was successfully dilated. The LV pacing lead could then be inserted and no complications occurred. CONCLUSION: Venoplasty for stenosis was effective in allowing deployment of a LV lead into a target vein in some patients. The safety and complications of the procedure remain unclear.
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Soga et al. (2007) conducted an observational in Heart failure requiring cardiac resynchronization therapy with coronary vein stenosis (n=208). Coronary venoplasty was evaluated on Successful deployment of a left ventricular lead into a target vein. Coronary venoplasty successfully enabled left ventricular lead implantation in all 4 patients with severe coronary vein stenosis, without any procedural complications.
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