Safety and efficacy of orthodromic snare technique in left ventricular lead delivery in cardiac resynchronization implantation.

IF 1.7 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Pace-Pacing and Clinical Electrophysiology Pub Date : 2024-10-01 Epub Date: 2024-08-29 DOI:10.1111/pace.15066

Sutopa Purkayastha, Olga Reynbakh, Suraj Krishnan, Nils Guttenplan

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Abstract

Background: Cardiac resynchronization therapy (CRT) improves ventricular function, but a positive response to CRT is often limited due to left ventricular (LV) lead placement in a suboptimal position. Complex coronary venous anatomy can hinder the placement of an LV lead in the target vessel, leading to poor CRT response.

Objective: To report experience with snare-assisted LV lead delivery in CRT and compare outcomes with the conventional LV lead delivery.

Methods: This is a single-center retrospective case-control study of CRT implants between 2016 and 2021. Snare-assisted lead delivery was performed in cases where conventional lead placement failed or when a preferred target vessel had anatomy amenable to the technique. Safety and outcomes were compared to conventional LV lead placement cases.

Results: Among 180 CRT cases, 33 were snare-assisted, and 147 were conventional LV lead placements. Median follow-up was 924 days in the snare and 618.5 days in the control group. The lead placement was successful in 28/33 snare and 138/147 control cases. A mid-vessel segment was attained in 89.3% of snare and 72.5% of control cases(p = .03). The apical position was more frequently observed in the control group (26.8% vs. 7.1%, p = .03). All-cause mortality trended lower in the snare group (6.1%) compared to (17.1%) in the control group (p = .13).

Conclusion: Snare-assisted LV lead delivery is a safe and effective technique that can be utilized for overcoming complex venous anatomy.

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心脏再同步植入术中左心室导联输送正畸套环技术的安全性和有效性。

背景：心脏再同步化疗法（CRT）可改善心室功能，但由于左心室导联放置位置不佳，CRT的积极反应往往受到限制。复杂的冠状静脉解剖结构会阻碍将左心室导联置入靶血管，导致 CRT 反应不佳：报告在 CRT 中使用套管辅助 LV 导联置入术的经验，并将结果与传统 LV 导联置入术进行比较：这是一项单中心回顾性病例对照研究，研究对象为 2016 年至 2021 年间植入的 CRT 患者。在常规导联置入失败或首选靶血管解剖结构适合该技术的情况下，进行卡钳辅助导联置入。结果：在180例CRT病例中，33例为钳夹辅助，147例为常规左心室导联置入。套管组的中位随访时间为 924 天，对照组为 618.5 天。28/33例抢救成功，138/147例对照成功。89.3%的卡环病例和72.5%的对照病例达到了血管中段（p = .03）。对照组更常观察到顶端位置（26.8% 对 7.1%，p = 0.03）。钳夹组的全因死亡率（6.1%）与对照组的（17.1%）相比呈下降趋势（p = .13）：卡环辅助左心室导联置入术是一种安全有效的技术，可用于克服复杂的静脉解剖结构。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pace-Pacing and Clinical Electrophysiology 医学-工程：生物医学

CiteScore

2.70

自引率

5.60%

发文量

209

审稿时长

2-4 weeks

期刊介绍： Pacing and Clinical Electrophysiology (PACE) is the foremost peer-reviewed journal in the field of pacing and implantable cardioversion defibrillation, publishing over 50% of all English language articles in its field, featuring original, review, and didactic papers, and case reports related to daily practice. Articles also include editorials, book reviews, Musings on humane topics relevant to medical practice, electrophysiology (EP) rounds, device rounds, and information concerning the quality of devices used in the practice of the specialty.

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