49 Coronarsinus — Vein — Angioplasty for Implantation of Left Ventricular Leads in Cardiac Resynchronization Therapy

Abstract

Background: Cardiac resynchronization therapy (CRT) has demonstrated improvement of symptoms, quality of live and prognosis in heart failure patients (pts) with left ventricular asynchrony. Tortuous or obstructed cardiac veins may prevent transvenous deployment of the left ventricular (LV) lead in the coronary sinus (CS) target vein. Therefore we studied the feasibility and the results of balloon angioplasty of coronary sinus veins (CS PTA) for LV lead implantation. Methods and results: Forty-three consecutive pts with typical indications for CRT (mean age 66 411 years, NYHA functional class 3.2 40.5, LV-EF: 24 48%, QRS duration: 175 417 ms) underwent biventricular device implantation. The transvenous implantation succeeds in 39 (93%) pts. In 2 pts a brief vein stenosis (< 1 cm) was present in the proximal part of the target vein. One third patient suffered from a pronounced convolution of the target vein origin. In all of these 3 pts a transvenous LV lead implantation was impossible although an adequate guide wire was positioned in the target vein. After dilatation with a standard 3.0 m m coronary angioplasty balloon positioning of an over-the-wire-lead was possible in all of the 3 pts (picture). LV-leads: Medtronic Attain OTW 4193, Guidant Easytrak 1 und 3.