Left ventricular lead stabilization guided by coronary vein anatomy resulted in a significantly higher proportion of CRT super-responders compared to standard placement (46% vs. 21%, P<0.005).
Cohort (n=302)
Does coronary vein anatomy-guided left ventricular lead stabilization reduce lead dislodgement and improve clinical outcomes in patients undergoing cardiac resynchronization therapy?
Coronary vein anatomy-guided LV lead stabilization prevents lead dislodgement in high-risk patients and is associated with higher rates of CRT super-response.
Absolute Event Rate: 46% vs 21%
p-value: p=< 0.005
AIMS: Left ventricular (LV) lead dislodgement occurs in about 10.6% of patients in the first 12 months after cardiac resynchronization therapy defibrillator implantation, and causes lack of clinical improvement, repeated surgery, and predisposes to infective complications and death. To understand the factors predictive of lead dislodgement, and to investigate whether bipolar LV lead stabilization can reduce the dislodgement rate and improve the clinical outcome. METHODS AND RESULTS: Predisposing coronary vein anatomy was identified on a retrospective series of 218 patients implanted before August 2009. Lead stabilization guided by vein anatomy was prospectively tested on consecutive patients from October 2009 to December 2010. Among 84 patients, lead stabilization based on vein anatomy was recommended in 19 patients, of which 16 agreed and 3 refused. Two of these latter had lead dislodgement within 1 month, whereas none of the former had adverse events during 23.8 ± 3.1 months follow-up. Only 1 of 58 patients deemed at low risk had lead dislodgement. Seven patients required lead stabilization for severe phrenic stimulation issues that dictated lead placement at specific sites. Patients with stabilized LV leads were more likely to be cardiac resynchronization therapy (CRT) responders than the others: 19 of 26 (73%) vs. 34 of 58 (59%, P= NS), and had a significantly higher proportion of super-responders: 12 of 26 (46%) vs. 12 of 58 (21%, P< 0.005). CONCLUSION: Coronary vein anatomy may assist decision making about the need for LV lead stabilization, and the choice of tools during the implanting procedure to ensure effective CRT delivery at long term.
Biffi et al. (Thu,) conducted a cohort in Patients undergoing cardiac resynchronization therapy defibrillator implantation (n=302). Left ventricular lead stabilization guided by coronary vein anatomy vs. Standard placement without stabilization was evaluated on Super-responder to cardiac resynchronization therapy (p=< 0.005). Left ventricular lead stabilization guided by coronary vein anatomy resulted in a significantly higher proportion of CRT super-responders compared to standard placement (46% vs. 21%, P<0.005).