Experience with coronary sinus lead implantations for cardiac resynchronization therapy in 244 patients

Azizi, M.; Castel, María Ángeles; Behrens, S.; Rödiger, W; Nägele, Herbert

doi:10.1007/s00399-006-0502-4

Cited by 27 publications

(20 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…PNS is found in 13%-18% of CRT implantations, and it is one of the main reasons for intraoperative lead repositioning from an anatomically acceptable location. 18,19 Pacing with high energy during implantation may help to avoid subsequent PNS, but despite high-energy stimulation, intraoperative testing in a supine position cannot rule out later PNS in other body positions, 20 even if the electrode remains in the same place. In seven cases, a new, minimally invasive method was performed using an ablation catheter for repositioning of the lead via a femoral approach.…”

Section: Discussionmentioning

confidence: 99%

Long-term experience with coronary sinus side branch stenting to stabilize left ventricular electrode position

et al. 2011

View full text Add to dashboard Cite

BACKGROUND Despite technical advancements, implantation of coronary sinus (CS) leads may be challenging, and dislocation remains a relevant clinical problem.OBJECTIVE The aim of this study was to investigate the effectiveness, safety, and long-term outcome of stent implantation to anchor the lead to the wall of the CS side branch. METHODSStenting of a CS side branch was performed in 312 patients. The procedure was performed because of postoperative lead dislocation in 16 patients and because of an intraoperative unstable lead position or phrenic nerve stimulation in 296 cases. A bare metal coronary stent was introduced over a second guide wire in the same CS sheath. The stent was deposited 5-35 mm proximal to the most proximal electrode. Mechanical damage of the CS side branch or pericardial effusion was not observed owing to stenting. RESULTSDuring follow-up (median 28.4, interquartile range 15-37, maximum 70 months), a clinically important increase in the left ventricular pacing threshold was found in four cases and reoperation was necessary in only two patients (0.6%). Phrenic nerve stimulation was observed in 18 instances, and repositioning with an ablation catheter was performed in seven cases. Impedance measurements did not suggest lead insulation failure. Three stented leads were extracted without complication after 3-49 months owing to infection, while four leads were extracted easily during heart transplantation after 7-27 months.CONCLUSION Stent implantation to stabilize CS lead position seems to be an effective and safe procedure in prevention and treatment of CS lead dislocation in selected cases.KEYWORDS Cardiac resynchronization; LV lead implantation; Coronary sinus; Lead dislocation; Stent implantation ABBREVIATIONS CRT ϭ cardiac resynchronization therapy; CS ϭ coronary sinus; INR ϭ international normalized ratio; LV ϭ left ventricle; NYHA ϭ New York Heart Association; PNS ϭ phrenic nerve stimulation (Heart Rhythm 2011;8:845-850)

show abstract

Section: Discussionmentioning

confidence: 99%

Long-term experience with coronary sinus side branch stenting to stabilize left ventricular electrode position

et al. 2011

View full text Add to dashboard Cite

show abstract

“…In seven other cases the cause of lead repositioning was phrenic nerve stimulation. Pacing with high energy during implantation may help to avoid subsequent PNS, but despite high energy stimulation, intraoperative testing in a supine position cannot rule out later PNS in other body positions [12], even if the electrode remains in the same place. In seven cases a new, minimally invasive method was performed using ablation catheter for repositioning.…”

Section: Discussionmentioning

confidence: 99%

CRT implantation: Lead stabilization using coronary sinus side branch stenting

Szilágyi

Merkely

Molnár

et al. 2011

IMAS

View full text Add to dashboard Cite

Abstract:Objective: We describe a method to stabilize CS lead position using stent implantation in a CS side branch to anchor the electrode to the wall of the vein, in cases of intraoperative or postoperative lead dislocation, unstable lead position and phrenic nerve stimulation (PNS). Methods: 403 patients were treated with stenting. After finding the desired lead position bare metal coronary stent was introduced via another guide wire, but in the same CS sheath. The stent was deposited 5-35 mm proximal to the tip of the electrode with a pressure of 6 to 14 atmospheres. Results: Mechanical damage of the CS side branch or pericardial effusion was not observed. During follow-up (median 39, 23-48, max. 82 months) re-operation was necessary in only two patients because of high pacing threshold, while repositioning with ablation catheter was performed in 7 cases because of PNS. Impedance measurements did not suggest lead insulation failure. Transvenous extraction of stented CS leads was successful after 3, 18 and 49 months, while 4 leads were extracted easily during heart transplantation. Conclusion: Stent implantation to stabilize CS lead position seems to be effective and safe for the prevention and treatment of CS lead dislocation in special cases.

show abstract

“…The rate of CS perforation has seen an upturn with increased CS cannulation during LV lead insertion for cardiac resynchronization therapy (CRT). The incidence of CS dissection and CS perforation have been reported to vary from 2%-4%, 0.3%-2%, respectively [17]. Cardiac tamponade and pericarditis have been reported with a CS perforation [18].…”

Section: Coronary Sinus (Cs) Dissection/perforationmentioning

confidence: 99%