Usefulness of electroanatomical mapping during transseptal endocardial left ventricular lead implantation

Kutyifa, Valentina; Merkely, Béla; Szilágyi, Szabolcs; Zima, Endre; Róka, Attila; Király, Ákos; Osztheimer, István; Molnár, Levente; Gellér, László

doi:10.1093/europace/eur353

Cited by 15 publications

(9 citation statements)

References 27 publications

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“…In a recent sub‐analysis from the Alternate Site Cardiac Resynchronization (ALSYNC) study, Biffi et al found that prior non‐responders to CRT were able to improve on LV endocardial pacing via the trans‐septal route . Many experiences have been published on LV pacing via trans‐septal approach, but no randomized studies have compared its efficacy with that of the epicardial approach.…”

Section: Discussionmentioning

confidence: 99%

Epicardial left ventricular lead implantation in cardiac resynchronization therapy patients via a video‐assisted thoracoscopic technique: Long‐term outcome

Marini

Branzoli

Moggio

et al. 2019

Clinical Cardiology

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Background Epicardial placement of the left ventricular (LV) lead via a video‐assisted thoracoscopic (VAT) approach is an alternative to the standard transvenous technique. Hypothesis Long‐term safety and efficacy of VAT and transvenous LV lead implantation are comparable. To test it, we reviewed our experience and we compared the outcomes of patients who underwent implantation with the two techniques. Methods The VAT procedure is performed under general anesthesia, with oro‐tracheal intubation and right‐sided ventilation, and requires two 5 mm and one 15 mm thoracoscopic ports. After pericardiotomy at the spot of the epicardial target area, pacing measurements are taken and a spiral screw electrode is anchored at the final pacing site. The electrode is then tunneled to the pectoral pocket and connected to the device. Results 105 patients were referred to our center for epicardial LV lead implantation. After pre‐operative assessment, 5 patients were excluded because of concomitant conditions precluding surgery. The remaining 100 underwent the procedure. LV lead implantation was successful in all patients (median pacing threshold 0.8 ± 0.5 V, no phrenic nerve stimulation) and cardiac resynchronization therapy was established in all but one patient. The median procedure time was 75 min. During a median follow‐up of 24 months, there were no differences in terms of death, cardiovascular hospitalizations or device‐related complications vs the group of 100 patients who had undergone transvenous implantation. Patients of both groups displayed similar improvements in terms of ventricular reverse remodeling and functional status. Conclusions Our VAT approach proved safe and effective, and is a viable alternative in the case of failed transvenous LV implantation.

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Section: Discussionmentioning

confidence: 99%

Epicardial left ventricular lead implantation in cardiac resynchronization therapy patients via a video‐assisted thoracoscopic technique: Long‐term outcome

Marini

Branzoli

Moggio

et al. 2019

Clinical Cardiology

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“…Venous anatomy dictates the limited number of sites at which LV pacing can be achieved with epicardial placement. A wider range of possible implant sites can be accessed via the endocardial approach allowing increased ability to select the hemodynamically optimal site 24 and risks of phrenic nerve stimulation are dramatically reduced. Although all techniques for TS endocardial LV pacing require a TS puncture, with the advent of atrial fibrillation ablation, this has become a maneuver that many electrophysiologists are comfortable with.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, there have been reports of techniques to assist optimal LV site selection 24 . These approaches are, however, likely to be limited by the technical difficulty represented in maneuvering pacing leads across the interatrial septum and then on to optimal LV wall positions.…”

Section: Discussionmentioning

confidence: 99%

Transseptal Left Ventricular Lead Placement Using Snare Technique

Wright

Tomlinson

Lines

et al. 2012

Pacing Clinical Electrophis

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“…This latter technique is an alternative for superior transseptal attempts using standard equipment and it is also applicable for pacing sites that are more easily reachable by the femoral approach. During transseptal LV lead implantation, Kutyifa et al successfully applied electroanatomical mapping to identify the location of the transseptal puncture and to achieve an optimal LV lead position …”

Section: Alternative Techniquesmentioning

confidence: 99%

Alternative Techniques for Left Ventricular Pacing in Cardiac Resynchronization Therapy

Mihálcz

Kassai

Gellér

et al. 2013

Pacing Clinical Electrophis

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Cardiac resynchronization therapy (CRT) is an important treatment modality for a well-defined subgroup of heart failure patients. Coronary sinus (CS) lead placement is the first-line clinical approach but the insertion is unsuccessful in about 5-10% of the patients. In recent years, the number of CRT recipients and the considerable need for left ventricular (LV) lead revisions increased enormously. Numerous techniques and technologies have been specifically developed to provide alternatives for the CS LV pacing. Currently, the surgical access is most frequently used as a second choice by either minithoracotomy or especially the video-assisted thoracoscopy. The transseptal or transapical endocardial LV lead implantations are being developed but there are no longer follow-up data in larger patient cohorts. These new techniques should be reserved for patients failing conventional or surgical CRT implants. In the future, randomized studies are needed to asses the potential benefits of some alternative LV pacing techniques and other new technologies for LV lead placement are expected.

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Usefulness of electroanatomical mapping during transseptal endocardial left ventricular lead implantation

Abstract: Electroanatomical mapping is a useful technical tool to guide endocardial LV lead implantation. It helps to identify the location of the transseptal puncture and the use of activation mapping might facilitate location of the optimal lead positions during CRT.

Cited by 15 publications

References 27 publications

Epicardial left ventricular lead implantation in cardiac resynchronization therapy patients via a video‐assisted thoracoscopic technique: Long‐term outcome

Epicardial left ventricular lead implantation in cardiac resynchronization therapy patients via a video‐assisted thoracoscopic technique: Long‐term outcome

Transseptal Left Ventricular Lead Placement Using Snare Technique

Alternative Techniques for Left Ventricular Pacing in Cardiac Resynchronization Therapy

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