Experience with 255 transvenous coronaory sinus lead inplantation for cardiac resynchronization therapy

Abstract

Cardiac Resynchronization therapy (CRT) using coronary sinus (CS) leads is a new method for the therapy of congestive heart failure (CHF) in the case of inter- and intraventricular conduction delays. Because the intervention is more complex than regular pacemaker implantations more informations on the feasibility of this intervention are of interest. From 1999-2004 n=255 transvenous coronary sinus leads were implanted in 234 CHF patients (mean age 61±17 years, 14-90 years age spectrum). 88% were over the wire leads, 71% preshaped and over the wire. Perioperative data were analyzed retrospectively. 84% of pts. were male, 44% of pts. had coronary artery disease, 30% of pts. were in atrial fibrillation, 78 pts. had preexisting pacemakers (upgrade procedure). 43 (16%) were implanted from the right subclavian vein, the others from the left side. Coronary sinus leads were positioned according to variable vein anatomies: 130x posterolateral, 97x anterolateral and 28x anterior (A). The mean operation time was 110 min +−, mean fluo time was 15,8 +− 11min. Severe complications were: CS dissection 5 cases (contrast media paravasation), ventricular fibrillation: 4 cases (defibrillation needed), asystole: 5 (pacing needed), pulmonary edema: 1 case, pneumothorax: 2 cases, acute CS lead dislodgement 5 cases, infection 1 case. In total we observed 23 severe complications. 12 patients had phrenic nerve stimulation, 5 of them needed reoperation. There were no death during the perioperative phase. 88% of pts. showed an improvement in their NYHA class and could be classified as responders unregardless of the underlying disease, the preexistence of atrial fibrillation or a conventional pacemaker. In regard to anterior lead position the rate of responders was lower (55%). Coronary sinus lead implantation is a complex procedure with some hazards. The complication rate is in the range of 10%, but in our series these could be managed without mortality or persistent morbidity. Most patients responded very well to the procedure. Therefore CRT should be offered to otherwise untreatable CHF patients. Anterior CS lead positions should be avoided.