Coronary sinus side branches for cardiac resynchronization therapy: prospective evaluation of availability, implant success, and procedural determinants.
BACKGROUND
There are only sparse data concerning individual coronary side branch (CS-SB) anatomy with respect to LV lead implantation for cardiac resynchronization therapy (CRT).


METHODS
In patients (pts) undergoing CRT device implantation, a detailed venogram was obtained, and the CS-SB of first, second, third, and fourth choices for CS-lead implantation was defined. Study endpoints included successful LV lead implantation in the first choice CS-SB, number of CS-SB potentially available, implantation success in selected CS-SB, procedural variables, and 6-month response to CRT.


RESULTS
CRT defibrillator implantation was attempted in 77 pts. Only 1 suitable CS-SB was present in 3 (4%), 2 in 20 (26%), 3 in 36 (47%), and 4 CS-SB in 18 patients (23%). The LV lead was implanted in the first choice CS-SB in 71% of patients, in the second choice in 16%, in the third choice in 3%. In 4 patients (5%) no LV lead could be implanted. Implant success was similar for different CS-SB regions (P = ns). Successful LV lead implantation in the CS-SB of first choice was associated with median fluoroscopy and procedure times of 20 +/- 13 and 143 +/- 41 minutes. Corresponding times for the CS-SB of >or= second choice were 38 +/- 21 (P = 0.002) and 179 +/- 47 minutes (P = 0.002). Response rate at 6 months was 64% for patients with LV leads in the first target CS-SB.


CONCLUSIONS
In 70% of patients undergoing CRT device implantation, at least three suitable CS-SBs are available. Implant success in the CS-SB of first choice is 71% without significant differences for any particular CS-SB region.
Duray
Gabor Z
GZ
Department of Medicine, Division of Cardiology, Section Clinical Electrophysiology, J. W. Goethe University, Frankfurt, Germany.
Hohnloser
Stefan H
SH
Israel
Carsten W
CW
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D054326:Coronary Sinus; D004554:Electric Countershock / Q000295:instrumentation* / Q000379:methods*; D004567:Electrodes, Implanted; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D016896:Treatment Outcome