title: Technical aspects of implantation of LV lead for cardiac resynchronization therapy in chronic heart failure.
abstract: The goal of this study was to analyze total procedural and fluoroscopic time during initial experience with implantation of LV lead in a single center, and to assess the performance of electrophysiologically-guided approach for cannulation of the coronary sinus (CS) in a subsequent period. Over an initial period of 29 months, a total of 46 attempts to implant biventricular pacing system were revised. During the first phase, only one type of LV electrode was available for three implanters (11 attempts). The second phase covered their early experience with other stylet-controlled LV leads (10 attempts). Additional LV leads including the over-the-wire design were available in the third phase and 25 attempts were done by he most experienced implanter. In a period of advanced experience, 92 implant procedures performed by four implanters using an electrophysiologically-guided approach to CS cannulation were revised. In the first period, success rates for different phases reached 70%, 90%, and 96%, respectively. Significant decrease in both procedural and fluoroscopic times was achieved with increased experience (Phase I: 247.1 +/- 104.5 minutes and 31.2 +/- 34.3 minutes, Phase II: 219.4 +/- 85.6 minutes, and 22.9 +/- 19.1 minutes, Phase III: 116.4 +/- 89.9 minutes and 6.6 +/- 4.4 minutes, respectively, P < 0.05). Advanced experience with electrophysiologically-guided approach to CS cannulation allowed achievement of this target within a reasonable amount of time (15.4 +/- 16.3 minutes) and with minimum fluoroscopic time (2.1 +/- 2.9 minutes). In conclusion, both individual learning curve and technical advances significantly influence success rate, procedural, and fluoroscopic times for biventricular system implantation. Electrophysiologically-guided approach makes cannulation of the CS a highly reproducible procedure that requires minimum fluoroscopic time.
authors.affiliation: Department of Cardiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. josef.kautzner@medicon.cz
authors.forename: Josef
authors.initials: J
authors.lastname: Kautzner
authors.forename: Lucie
authors.initials: L
authors.lastname: Riedlbauchová
authors.forename: Robert
authors.initials: R
authors.lastname: Cihák
authors.forename: Jan
authors.initials: J
authors.lastname: Bytesník
authors.forename: Vlastimil
authors.initials: V
authors.lastname: Vancura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002983:Clinical Competence; D004562:Electrocardiography; D004567:Electrodes, Implanted / Q000706:statistics & numerical data; D005260:Female; D005471:Fluoroscopy; D006333:Heart Failure / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D013223:Statistics as Topic; D013996:Time and Motion Studies