Abstract
Cardiac resynchronization therapy (CRT) is an effective nonpharmacological therapeutic method for the treatment of selected patients with chronic heart failure with a wide QRS complex and mechanical dyssynchrony of cardiac ventricles. A new technique is used to stabilize the implanted coronary sinus lead in an appropriate position with an expanded coronary stent to maintain synchronous pacing of the left ventricle. The extraction of the previously stented lead might be indicated for any medical or technical reason. Neither the capability to stabilize the lead, nor the lead removal procedure and the necessary physical activity of extraction have been evaluated yet. The aim of our study is to simulate the extraction of a stent stabilized coronary sinus lead in in-vitro experiments. We evaluated the additional stabilization capability of the technique, as well as the extraction force needed to pull out the CS lead using stabilizing stents with different diameters and lengths.
Highlights
Cardiac resynchronization therapy (CRT) is an effective nonpharmacological therapeutic method for the treatment of selected patients with chronic heart failure with a wide QRS complex and mechanical dyssynchrony of cardiac ventricles
We evaluated the additional stabilization capability of the technique, as well as the extraction force needed to pull out the coronary sinus (CS) lead using stabilizing stents with different diameters and lengths
The recorded force displacement curve was not analyzed because the effective extraction force applied was outside the range of usable removing power
Summary
Cardiac resynchronization therapy (CRT) is an effective nonpharmacological therapeutic method for the treatment of selected patients with chronic heart failure with a wide QRS complex and mechanical dyssynchrony of cardiac ventricles. The recently published MADIT CRT trial showed that 7.5% of the coronary sinus (CS) lead implantations were unsuccessful and 5-10% of patients required re-operation during the follow-up period, due to CS lead dysfunction [1,2,3]. Stent implantation may improve the stability of the lead position stabilizing the CS lead to the wall of the CS side branch. A stable lead position may improve the implantation success rate and decrease postoperative complications. The long-term results of the technique are promising, it is still not known whether the implanted coronary sinus lead can be and safely extracted without damaging the lead in case of system infections or potential CS lead replacements [4]. We evaluated the additional stabilization capability of the technique as well as the extraction force needed to pull out the CS lead using stabilizing stents with different diameters and lengths
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