Effect of percutaneous interventions within the coronary sinus on the success rate of the implantations of resynchronization pacemakers.
BACKGROUND
Cardiac resynchronization therapy (CRT) becomes a "gold standard" in therapy of selected patients with advanced heart failure. We set out to evaluate the feasibility and safety of percutaneous interventions within coronary sinus (CS) and their effect on the success rate of left ventricular (LV) lead implantation during CRT.


METHODS
The study analyzed eight consecutive patients with the indications for CRT, who needed additional procedures within CS to overcome technical problems during left ventricular (LV) electrode implantation. The analyzed group consisted of three subgroups: patients in whom percutaneous balloon angioplasty within CS was needed (n = 4); patients with acute instability of the lead, requiring stenting of the vein to fix the electrode (n = 2); and patients with the stenting of CS due to late dislocation of the lead (n = 2). Success rate, procedure duration, fluoroscopy, complications, and electrical parameters of leads were analyzed.


RESULTS
Success rate of the procedures was 87.5%; additional interventions increased overall efficacy of CRT implantation at our center from 88% to 98% (P < 0.05). Procedure duration (155.0 minute) and fluoroscopy time (42.5 minute) remained acceptable for the patient and operator; however, both were higher than in the procedures performed routinely in our hospital. Electrical properties of the LV leads were stable and within normal ranges during the observation period. We noted two local dissections of CS during the procedure, which remained clinically silent.


CONCLUSIONS
Percutaneous interventions within CS seem to be feasible and safe treatment options, which can improve the short- and long-term success rates of CRT.
Kowalski
Oskar
O
First Department of Cardiology, Silesian Centre for Heart Disease, Zabrze, Poland.
Lenarczyk
Radosław
R
Prokopczuk
Janusz
J
Pruszkowska-Skrzep
Patrycja
P
Zielińska
Teresa
T
Sredniawa
Beata
B
Musialik-Łydka
Agata
A
Pluta
Sławomir
S
Kukulski
Tomasz
T
Szulik
Mariola
M
Poloński
Lech
L
Kalarus
Zbigniew
Z
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003331:Coronary Vessels; D005240:Feasibility Studies; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D015607:Stents