Implantation of left ventricular leads using a telescopic catheter system.
BACKGROUND
Implantation procedures for cardiac resynchronization therapy (CRT) remain challenging with regard to coronary sinus (CS) cannulation and left ventricular (LV) lead positioning. Technologic advances in catheter design may facilitate CS cannulation and LV lead placement.


OBJECTIVE
To evaluate two different telescoping dual-catheter systems, RAPIDO Guiding Catheter System (Group R) and RAPIDO ADVANCE Guiding Catheter System (Group A) (Guidant Inc., St. Paul, MN, USA), during implantation of a CRT device.


METHODS
Seventy-four consecutive patients randomly received a CRT device using the R or A system.


RESULTS
An LV lead was successfully implanted in 74 patients (100%). (1) Median times for CS cannulation in groups R and A were 0.3 minutes (range from 0.05 to 14 minutes) and 0.5 minutes (range from 0.05 to 9 minutes), respectively (P = NS). (2) Median times for LV lead placement were 8 minutes (range from 0.8 to 100 minutes) and 3.5 minutes (range from 0.25 to 30 minutes), respectively, for groups R and A (P = 0.032). (3) Median total fluoroscopy times were 12.33 minutes (range from 5 to 70 minutes) and 14.33 minutes (range from 6 to 53 minutes) for groups R and A, respectively (P = NS). (4) Median procedural times for CRT implantation were 80 minutes (range from 40 to 200 minutes) and 75 minutes (range from 45 to 180 minutes) (P = NS) in groups R and A, respectively. There were no major complications.


CONCLUSIONS
CS cannulation and LV lead placement with a telescopic dual-catheter system is a safe and feasible approach that may reduce fluoroscopy and overall CRT implantation times. Our observations suggest that the RAPIDO ADVANCE System is faster than the RAPIDO System in terms of median time for LV lead positioning.
Zanon
Francesco
F
Division of Cardiology, Rovigo General Hospital, Rovigo, Italy. franc.zanon@iol.it
Baracca
Enrico
E
Pastore
Gianni
G
Aggio
Silvio
S
Rigatelli
Gianluca
G
Dondina
Cristina
C
Marras
Gilla
G
Braggion
Gabriele
G
Boaretto
Graziano
G
Cardaioli
Paolo
P
Galasso
Mariapaola
M
Zonzin
Pietro
P
Barold
S Serge
SS
D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation* / Q000379:methods; D002304:Cardiac Pacing, Artificial / Q000379:methods; D004567:Electrodes, Implanted; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008297:Male; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome