title: Primary failure of cardiac resynchronization therapy: what are the causes and is it worth considering a second attempt? A single-centre experience.
abstract: OBJECTIVE
  Cardiac resynchronization therapy (CRT) has been validated as an effective treatment for patients with drug-refractory congestive heart failure and left bundle branch block. Failure of implantation of the left ventricular (LV) lead has been reported in 10-15% of patients. The goal of our study was to determine the causes of failure and the success rate following a repeat procedure by the same operators.
  
  
  RESULTS
  We reviewed our last 100 consecutive cases of CRT before July 2007. The procedure was considered as unsuccessful if it had to be interrupted before the placement of the LV lead in an appropriate position, because of patient's haemodynamic status or if the procedure duration exceeded 3 h. Cardiac resynchronization therapy was unsuccessful in 10 patients (5 men, mean age: 72 +/- 11 years). The causes of failure of CRT were as follows: no target vein other than the great cardiac vein (n = 5), coronary sinus dissection (n = 1), and a lateral vein too small to provide a stable location for the LV lead (n = 4). A second procedure was attempted in four patients and was successful in all cases.
  
  
  CONCLUSIONS
  In our study results, failure of CRT was observed in 10% of the patients. A second procedure can be attempted in a selected group of patients and is associated with a high success rate.
authors.affiliation: Department of Cardiology, Brest University Hospital, CHU de la Cavale Blanche, Brest Cedex, France. marjaneh.fatemi@chu-brest.fr
authors.forename: Marjaneh
authors.initials: M
authors.lastname: Fatemi
authors.forename: Yves
authors.initials: Y
authors.lastname: Etienne
authors.forename: Philippe
authors.initials: P
authors.lastname: Castellant
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Blanc
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002304:Cardiac Pacing, Artificial; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome