Permanent Left Ventricular Pacing With Transvenous Leads Inserted Into The Coronary Veins

Abstract

This paper describes a preliminary experiment-conducted jointly by 2 centers-of permanent left ventricular pacing using leads inserted by the transvenous route and through the coronary sinus into the cardiac veins of the left ventricle free wall. The aim was to obtain permanent biventricular pacing in a totally endocavitary configuration in patients with severe LV dysfunction and drug-refractory heart failure. Two types of leads were used: nonspecific unipolar leads at the beginning of the experiment, followed by leads specifically designed to be used in the coronary sinus in a second step. The electrode could be fitted in an adequate location in 35 of the 47 patients (75.4%), with a 1.15 +/- 0.7 V acute pacing threshold and 11.8 +/- 5.7 mV R wave amplitude. The success rate was significantly higher with the specific electrodes (81.8% vs 53.3%, p < 0.001). The pacing and sensing thresholds upon implantation were not influenced by the type of lead or by the localization of the cardiac vein that was catheterized (great cardiac vein, lateral vein, postero-lateral or posterior vein, mid cardiac vein). In contrast, the pacing threshold was significantly lower (0.8 +/- 0.2 vs 1.8 +/- 0.8 V; p = 0.002) and the R wave amplitude tended to be greater (13.1 +/- 4.5 mV vs 9.3 +/- 6.5 mV; p = 0.07) when the tip electrode could be inserted distally into the vein, by comparison with a proximal site near the ostium. At the end of follow-up (10.2 +/- 8.7 months), 34 out of the 35 leads were still fully functional, with a chronic pacing threshold of 1.8 +/- 0.7 V and a R wave amplitude of 10.7 +/- 6 mV. To conclude, permanent LV pacing via the transvenous route is possible in most patients, with excellent safety and long-term results.

Terapia de resincronización cardíaca con o sin cardiodesfibrilador versus terapia con desfibrilador automático, Pereira (Colombia): un estudio de cohorte

“…Históricamente, el estudio de la muerte súbita y la insuficiencia cardíaca llevó a la necesidad de reconocer a las personas susceptibles del uso de terapias farmacológicas y cardiodesfibriladores (7,8,43); posteriormente, con los avances en las terapias de estimulación biventricular y el desarrollo de las derivaciones endocárdicas, se hizo factible el implante del resincronizador cardíaco (47). Como fruto de estos estudios se evidenció que la arritmia ventricular sintomática o asintomática, pero no la fibrilación auricular, aumentaba la frecuencia de muerte, lo cual concuerda con la idea de que la arritmia per se no es un marcador independiente de mortalidad, pero sí un indicador clínico del empeoramiento y progresión de la insuficiencia cardíaca.…”

Implantation Techniques of Leads for Left Ventricular Pacing in Cardiac Resynchronization Therapy and Electrocardiographic Consequences of the Stimulation Site

“…At the same time Bakker and colleagues reported their experiences (Bakker et al,2000), with epicardial LV pacing by thoracotomy. The transvenous approach via the coronary sinus (CS) tributaries was first published by Daubert in 1998 and was an important contribution in the application of cardiac resynchronization therapy (Daubert et al,1998) (Fig 1). The transvenous approach has been more and more developed and has become the implantation technique of choice.…”

Coronary Vein Extraction in MSCT Volumes Using Minimum Cost Path and Geometrical Moments

“…The procedure consists in pacing simultaneously or with a small delay, both the right ventricle (RV) and the left ventricle (LV). Daubert et al proposed a totally transvenous approach [2] using three pacing leads. Two are respectively positioned in the right atrium (l 3 ) and the RV (l 2 ) through the vena cava while the third one (l 1 ) is inserted through the coronary sinus into a venous branch that runs along the free wall of the left ventricle (see Fig.…”