Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
Department of Cardiology, Evagelismos Hospital, Athens, Greece.
Hellenic J Cardiol. 2018 Jan-Feb;59(1):26-33. doi: 10.1016/j.hjc.2017.07.008. Epub 2017 Aug 2.
Cardiac resynchronization therapy (CRT) device implantation is hampered by difficult placement of the left ventricular (LV) lead. We have routinely used a steerable electrophysiology catheter to guide coronary sinus (CS) cannulation and facilitate LV lead positioning. The aim of this prospective study is to present our results with this approach in 138 consecutive patients receiving a CRT device over 10 years.
The study included 120 men and 18 women, aged 64.8±11.4 years, with coronary disease (n=63), cardiomyopathy (n=72), or other disease (n=3), and mean ejection fraction of 24.5±4.5%. Devices were implanted for refractory heart failure and dyssynchrony, all but 2 in the presence of left bundle branch block. Implanted devices included biventricular pacemakers (CRT-P) (n=33) and cardioverter defibrillators (CRT-D) (n=105).
Using the electrophysiology catheter, the CS could be engaged in 134 (97.1%) patients. In 4 patients failing CS cannulation, a dual-chamber device was implanted in 2, and bifocal right ventricular pacing was effected in 2. Bifocal (n=2) or conventional (n=1) systems were implanted in another 3 patients, in whom the LV lead got dislodged (n=2) or removed because of local dissection (n=1). Thus, finally, a CRT system was successfully established in 131 (94.9%) patients. There were 3 patients with CS dissection, of whom 1 was complicated by cardiac tamponade managed with pericardiocentesis. There were no perioperative deaths. During follow-up (31.0±21.2 months), clinical improvement was reported by 108 (82.4%) patients.
Routine use of an electrophysiology catheter greatly facilitated CS cannulation and successful LV lead placement in ∼95% of patients undergoing CRT system implantation.
心脏再同步治疗（CRT）装置的植入受到左心室（LV）导联放置困难的阻碍。我们常规使用可转向的电生理导管来引导冠状窦（CS）插管并促进 LV 导联定位。本前瞻性研究的目的是在 10 年内对 138 例连续接受 CRT 装置治疗的患者使用这种方法的结果。
该研究包括 120 名男性和 18 名女性，年龄 64.8±11.4 岁，其中冠心病（n=63）、心肌病（n=72）或其他疾病（n=3），平均射血分数为 24.5±4.5%。除 2 例外，所有患者均因难治性心力衰竭和不同步而植入设备，且均存在左束支传导阻滞。植入的设备包括双心室起搏器（CRT-P）（n=33）和心脏复律除颤器（CRT-D）（n=105）。
使用电生理导管，134 例（97.1%）患者可进入 CS。在 4 例 CS 插管失败的患者中，2 例植入了双腔设备，2 例实施了双心室起搏。另外 3 例患者植入了双焦点（n=2）或传统（n=1）系统，其中 2 例 LV 导联脱位，1 例因局部解剖而取出。因此，最终 131 例（94.9%）患者成功建立了 CRT 系统。有 3 例 CS 夹层患者，其中 1 例并发心脏压塞，行心包穿刺引流治疗。无围手术期死亡。在随访（31.0±21.2 个月）期间，108 例（82.4%）患者报告了临床改善。
常规使用电生理导管可极大地促进 CS 插管和成功放置 LV 导联，约 95%的 CRT 系统植入患者受益。
