Adverse events with transvenous left ventricular pacing in patients with severe heart failure: early experience from a single centre.
OBJECTIVE
Assessment of complications following implantation of transvenous ventricular electrodes to pace the left ventricle.


RESULTS
Twenty-eight patients with severe cardiac failure and left bundle branch block were prospectively followed for adverse effects of implantation of a left ventricular transvenous pacing system. Immediate follow-up was associated with loss of left ventricular pacing in nine patients (32%). This was due to lead dislodgement in four cases (corrected by re-operation in three of these cases), and due to increased threshold in five cases (corrected by programming a higher pacing amplitude in all five cases, but with intermittent diaphragmatic contraction in one case). After 1 month, one patient died, one patient with severe coronary heart disease suffered a myocardial infarction, and left ventricular pacing was lost in two patients. Pericardial effusion, new significant ventricular arrhythmias or other adverse effects were not observed. After a mean follow-up of 16 +/- 9.2 months, pacing leads remained stable and no late complications related to the transvenous left ventricular epicardial pacing were observed.


CONCLUSIONS
Placement of a permanent lead in a tributary of the coronary sinus is feasible without serious adverse effects during the first month. The only frequent adverse event was lead dislodgement; a finding which emphasizes the need for development of specially designed leads for this application.
Department of Cardiology, Brest University Hospital, France.
V
V
Valls-Bertault
J
J
Mansourati
M
M
Gilard
Y
Y
Etienne
S
S
Munier
J J
JJ
Blanc
D000368:Aged; D002037:Bundle-Branch Block / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006352:Heart Ventricles; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011446:Prospective Studies; D015996:Survival Rate