Cardiac resynchronisation therapy in sinus rythm heart failure patients using a vdd lead

Abstract

Purpose of study Single-lead VDD pacing has shown a reduction in operating time and complications compared to the DDD mode. The objective of our study was to evaluate in sinus rhythm (SR) heart failure pts the interest and limits of a simplified CRT procedure with 2 leads, one VDD and one left ventricle (LV). Methods used Over a 1-year period (May 2002-May 2003), 8 consecutive heart failure pts (1/3 of CRT during the period) in SR, received CRT by the implant of a Medtronic InSync 8042 pacemaker with a Medtronic 5038 VDD lead and an LV lead chosen after per-operative coronary sinus angiography. Summary of results The 8 pts (average age 68±9 years, 5 male) were NYHA class III (3 pts) or IV (5 pts) ; the ejection fraction was 25±3 %. Six pts were primo-implants; 2 pts had VDD pacemakers for 3-7 years, upgraded by the addition of an LV lead. A right approach was used for the 2 upgraded pts and a left approach for the 6 others. There was 1 sub-clavian venous puncture for each implanted lead. The VDD lead was positioned at the right ventricular (RV) apex; sensing (p = 1,9±1,3 mV, R= 17±5,4 mV) and RV threshold (0,5±0,2 V) values were deemed satisfactory. All 8 LV leads were Medtronic 4193 placed in LV lateral veins. Mean implant duration was 133±27 mn versus 147±37 mn for a 3-lead CRT. No implant-related complication occured. 1 pt died of non-cardiac causes at M8; after an average 25 (19-31) months of follow-up, 7 pts are still living, 2 in NYHA class III, 5 in class II. Conclusion In heart failure patients without sinus dysfunction, 2-lead CRT with one VDD lead is achievable. With good atrial sensing, the procedure is simplified thus sparing venous capital and reducing implantation times in these fragile patients.