Key result
Ischaemic compared to non-ischaemic cardiomyopathy did not significantly affect the availability of more than one suitable vein for LV lead placement (36.8% vs 50.0%; P=0.16).
Why the study?
Differences in coronary venous anatomy between ischaemic and non-ischaemic cardiomyopathy patients may affect left ventricular lead targeting in cardiac resynchronization therapy.
Does underlying aetiology (ischaemic vs non-ischaemic) affect the quantity and distribution of coronary veins available for LV lead placement in patients undergoing CRT?
Observational (n=133)
Does underlying aetiology (ischaemic vs non-ischaemic) affect the quantity and distribution of coronary veins available for LV lead placement in patients undergoing CRT?
Coronary venous anatomy restricts LV lead placement to a single vein in almost half of CRT patients, regardless of ischaemic or non-ischaemic aetiology, suggesting prospective targeting may often require a surgical approach.
Answers are grounded in this paper and cite their sources.
No aetiology-based difference in CRT vein availability; leaves open whether venous mapping improves lead placement success.
AIMS: Recent studies suggest differences in coronary venous anatomy between patients with ischaemic (I) and non-ischaemic (N) cardiomyopathy. We hypothesize that these differences may affect the potential for left ventricular (LV) lead targeting in patients undergoing cardiac resynchronization therapy. METHODS AND RESULTS: The retrograde contrast venograms were retrospectively reviewed in 133 patients (age 68 +/- 9 years, 101 males). The quantity and distribution of veins were recorded as well as the final lead position. There were no major differences in the distribution of LV lead positions between I and N [posterior vein, 14.0% (I) vs. 15.8% (N); posterolateral vein, 21.1 vs. 18.4%; lateral vein, 59.7 vs. 50.0%; anterolateral vein, 3.5 vs. 13.2%; P= NS]. Excluding the middle and great cardiac veins, in total only 59 of 133 patients had more than one suitable vein as potential targets for LV lead placement (I, 36.8% vs. N, 50.0%; P = 0.16). CONCLUSION: Underlying aetiology does not affect the quantity and distribution of coronary veins available for LV lead placement. The limitations of venous anatomy restrict LV lead placement to a single vein with little scope for site selection in almost half of all the patients. Given these limitations, in many patients, prospective targeting of LV lead placement may require a direct surgical approach.
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Khan et al. (2009) conducted an observational in Cardiomyopathy undergoing cardiac resynchronization therapy (n=133). Ischaemic cardiomyopathy vs. Non-ischaemic cardiomyopathy was evaluated on More than one suitable vein as potential targets for LV lead placement (excluding middle and great cardiac veins) (p=0.16). Ischaemic compared to non-ischaemic cardiomyopathy did not significantly affect the availability of more than one suitable vein for LV lead placement (36.8% vs 50.0%; P=0.16).
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