Grebmer Christian, Bossard Matthias, Attinger-Toller Adrian, Kobza Richard, Hilfiker Gabriela, Berte Benjamin, Cuculi Florim
Department of Cardiology, Heart Center Lucerne, Luzerner Kantonsspital, Spitalstrasse 16, 6002 Luzern, Switzerland.
Eur Heart J Case Rep. 2023 Sep 11;7(9):ytad455. doi: 10.1093/ehjcr/ytad455. eCollection 2023 Sep.
Reducing venous drainage of the coronary sinus is a promising intervention for refractory angina. Coronary Sinus Reducer (CSR) System™ effectively treats patients with refractory angina, possibly by increasing coronary collateral circulation, and leads to an improvement in their symptoms and quality of life. In patients with impaired left ventricular function and electrocardiographic dyssynchrony, cardiac resynchronization therapy (CRT) is an established treatment. However, there is only one published case report of CRT in a patient implanted with a CSR system. We present the first case series of CRT in patients implanted with the CSR system.
This case series describes three patients. The first case demonstrated that CRT is feasible in patients implanted with a CSR system. The second case is the first report of a left ventricular lead extraction after CSR, and the third case was complicated due to the patient's medical history; however, CSR system implantation was feasible without major complications.
Our results suggest that CRT is feasible in patients implanted with a CSR system, and lead extraction after CSR system implantation is possible. However, lead extraction in cases of severe adhesions around the CSR system and the coronary sinus may be associated with a high risk of complications; alternative options should be discussed at an early stage.
减少冠状静脉窦的静脉引流是一种治疗顽固性心绞痛的有前景的干预措施。冠状静脉窦减压器（CSR）系统™能有效治疗顽固性心绞痛患者，可能是通过增加冠状动脉侧支循环实现的，并且能改善患者症状和生活质量。对于左心室功能受损和心电图不同步的患者，心脏再同步治疗（CRT）是一种已确立的治疗方法。然而，仅有一篇已发表的关于植入CSR系统的患者接受CRT治疗的病例报告。我们呈现了首例植入CSR系统的患者接受CRT治疗的病例系列。
该病例系列描述了三名患者。首例病例表明CRT在植入CSR系统的患者中是可行的。第二例病例是CSR术后左心室导线拔除的首例报告，第三例病例因患者病史而出现并发症；然而，植入CSR系统是可行的，且未出现重大并发症。
我们的结果表明CRT在植入CSR系统的患者中是可行的，并且CSR系统植入后拔除导线是可能的。然而，在CSR系统和冠状静脉窦周围存在严重粘连的情况下拔除导线可能会有较高的并发症风险；应尽早讨论替代方案。
