181: Cardiac resynchronization device implantation procedure in real life. The French Electra survey

Abstract

Cardiac resynchronization therapy (CRT) has been a major breakthrough in cardiac failure management. However, implantation procedure is not standardized. To evaluate routine implantation procedure habits in french practice. A survey was e-mailed to 100 French CRT implanters in November 2011. Physicians were interviewed on their own strategy in the center. Answers had to concern the most frequent routine attitude. If appropriate, physicians could answer “no standardized attitude or “other”. Among the 62 physicians who answered, 45% practise in a university hospital, 24% in a non-university hospital and 23% in a private institution. The rate of physician implantations is <30/year, 30-50/year and >50/year in 42%, 25% and 33%, respectively. Implantations are performed by a single operator in 49%, and in 43% by two physicians, 16% of implants being done under general anaesthesia. CRT-Pacemaker (CRT-P) implantations are right-sided in 18%, left-sided in 51%, unsettled in 20%, and for CRT-Defibrillator (CRT-D) 8%, 82 and 10% respectively. The venous approach is “all cephalic” in 21%, all subclavian in 18% and combined in 62%. First implanted lead is the right ventricular lead (RV) in 74%, and the coronary sinus (CS) lead in 23%. RV lead is placed in apical position in 26% and in septal position in 67%. To catheterize the CS, a sheath isused in first intention in 81%. CS angiography is performed in 90%, with an inflated balloon in 59%. In case of atrial fibrillation with CHA2DS2-vasc<2, 38% implant without VKA interruption, 57% stop VKA without substitution, and unfractionned heparin (UH) or low weight heparin (LWH) substitution is chosen in 5%, vs respectively 69% and 11% and 19% if CHA2DS2-vasc >4. Most of implantations are performed under local anesthesia. Left sided is prefered, especially in case of CRT-D implantation. Most physicians combine the venous accesses, start with the RV septal lead, and perform a CS angiogram via an inflated balloon. In AF patient, VKA interruption is preferred in low risk patients but not in high risk ones. Few implanters choose VKA substitution.