Impact of radiocontrast use during left ventricular pacemaker lead implantation for cardiac resynchronization therapy.
OBJECTIVE
The risk of contrast-induced nephropathy (CIN) with radiocontrast use during left ventricular (LV) lead placement for cardiac resynchronization therapy (CRT) is unknown. It is unclear as to whether minimizing contrast use impacts adequacy of LV lead placement.


RESULTS
A retrospective analysis was performed of all LV leads placed for CRT at Mayo Clinic, Rochester, MN from 16 March 2001 to 1 April 2009. The primary goal was to assess risk of CIN and adequacy of lead placement depending on the amount of contrast administered during CRT placement. Contrast-induced nephropathy was defined as a ≥25% increase in serum creatinine ≥48 h post-procedurally. Adequacy of lead placement was assessed in a blinded fashion by review of procedural fluoroscopic and post-procedural radiographic images. Eight hundred and twenty-two subjects were divided based on the amount of procedural contrast used into tertile 1 (<55 mL, 257 patients), tertile 2 (55-94 mL, 261 patients), and tertile 3 (≥95 mL, 304 patients). Contrast-induced nephropathy occurred in 5.4% of patients in tertile 1, 5.4% in tertile 2 and 11.8% in tertile 3 (P = 0.004). Among the tertiles, lead positioning was optimal in 95, 80 and 66%, respectively (P < 0.0001). Fluoroscopic time was 34 ± 23, 42 ± 26, and 48 ± 30 min in tertiles 1, 2, and 3 (P < 0.0001).


CONCLUSIONS
Risk of CIN with CRT implantations was substantial. Increased volume of radiocontrast used for LV lead placement was associated with substantially increased risk of CIN. Minimal contrast use was associated with decreased procedural times without adverse impact on adequacy of lead placement.
Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Gregory A
GA
Tester
Amit
A
Noheria
Heather L
HL
Carrico
Jennifer A
JA
Mears
Yong-Mei
YM
Cha
Brian D
BD
Powell
Paul A
PA
Friedman
Robert F
RF
Rea
David L
DL
Hayes
Samuel J
SJ
Asirvatham
D000368:Aged; D058406:Cardiac Resynchronization Therapy; D015897:Comorbidity; D003287:Contrast Media; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology*; D004567:Electrodes, Implanted; D005260:Female; D006352:Heart Ventricles; D006801:Humans; D007674:Kidney Diseases / Q000453:epidemiology*; D008297:Male; D008910:Minnesota / Q000453:epidemiology; D015995:Prevalence; D019919:Prosthesis Implantation; D018570:Risk Assessment; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology* / Q000517:prevention & control*
D003287:Contrast Media