title: Hemodynamic collapse during left ventricular lead implantation.
abstract: Hypotension as a procedural complication during cardiac resynchronization therapy (CRT) implantation was reported in the initial randomized clinical trials. However, this phenomenon is not well characterized. We reviewed our CRT implantation experience to better understand this issue. There were 105 patients who underwent left ventricular lead implantation for CRT. Four patients had marked hypotension (systolic blood pressure < or = 50 mmHg) during the procedure. All had a history of hypertension and diabetes mellitus and were pacemaker dependent. Two had normal renal function, one had moderate renal insufficiency, and one was on dialysis. Three patients had ischemic cardiomyopathy. All had left ventricular ejection fraction < or =20% and were in New York Heart Association class III. Propofol and midazolam were used for sedation as standard protocol. Two patients had sudden hypotension when the coronary sinus was being cannulated, and two patients experienced sudden hypotension during left ventricular pacing. Cardiac tamponade as a possible cause was ruled out by echocardiography. We discuss possible mechanisms of sudden hemodynamic collapse during CRT implantation.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Michigan State University, Sparrow Health System, Thoracic and Cardiovascular Institute, Lansing, Michigan 48910, USA.
authors.forename: Sujeeth R
authors.initials: SR
authors.lastname: Punnam
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Holiday
authors.forename: Renee
authors.initials: R
authors.lastname: Janes
authors.forename: Rabih
authors.initials: R
authors.lastname: Touma
authors.forename: Haiyan
authors.initials: H
authors.lastname: Li
authors.forename: Mehul
authors.initials: M
authors.lastname: Patel
authors.forename: George S
authors.initials: GS
authors.lastname: Abela
authors.forename: Ranjan K
authors.initials: RK
authors.lastname: Thakur
mesh_terms: D000368:Aged; D002304:Cardiac Pacing, Artificial / Q000009:adverse effects*; D004567:Electrodes, Implanted / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000009:adverse effects*; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology*