Initial experience with CRT systems implantation in electrocardiology department of silesian medical school, katowice, poland ¿ 12 consecutive cases report

Abstract

We present first 12 pts implanted with CRT systems in our department from 29.07.2004 to 22.12.2004. Pts were selected according to generally accepted indications to CRT including NYHA III-IV functional class despite optimal medical treatment, echocardiographic signs of inter-(average:54 ms, range[20-85]) and intraventricular(64ms[20-130]) dyssynchrony, EF 130ms (166ms[140-220]). We routinely collected QoL score, performed 6-min. walk test (300m[250-325]), spiroergometry and cardiac catheterization to visualize not only coronary arteries status but also coronary sinus anatomy. We attempted 13 procedures, 3 were unsuccessful due to: CS dissection, intraoperative lead dislodgement, CS access failure (learning curve!). We used Medtronic introducers, leads-mainly OTW 4193 and InSync III devices. One CRT ICD system was implanted (InSync III Marquis 7279). Procedures were performed under local anaesthesia. We always obtained CS anatomy, chose target vein and placed lead there. Pacing (1,7V[0,4-5,0]) and sensing (11mV[3,5-20]) parameters were acceptable, no permanent phrenic nerve stimulation occurred. There were no procedure-related complications, except one case of pneumothorax. Lead remained stable during follow-up. All our pts substantially improved in short follow-up period. Conclusions we are actually gaining experience and hope to perform CRT implantations with greater success rate, faster and with clear long-term clinical benefit for our pts.