Cardiac resynchronization therapy after coronary sinus lead extraction: feasibility and mid-term outcome of transvenous reimplantation in a tertiary referral centre.
OBJECTIVE
Few data are available on cardiac resynchronization therapy (CRT) after coronary sinus (CS) lead extraction. We aimed to evaluate the feasibility and mid-term outcome of transvenous CS lead reimplantation in a tertiary referral centre.


RESULTS
We enrolled all patients who were referred to our hospital for CS lead removal from December 2000 through to May 2009 and were transvenously reimplanted with a CRT system before June 2009. One-year follow-up was performed to evaluate the incidence of infections, malfunctions, and mortality. We studied 113 consecutive patients undergoing successful CS lead extraction; 90 patients (75 male, mean age 69.2, range 35-84) underwent CS lead reimplantation (success rate: 95.6%; right-sided approach: 64.4%). In these patients, cardiac device infection was the usual indication for extraction (74.4%) and the subsequent reimplantation was performed after a median time of 3 days. The coronary sinus lead was usually positioned in the left ventricular (LV) postero-lateral region (62.2%); two procedures were required in two cases (2.2%). Balloon angioplasty was necessary for two patients (failure in one), whereas for the others we used a conventional implant technique. During follow-up, we observed four cases (4.4%) of local infection and six cases (6.7%) of system malfunction, requiring reintervention (two cases during the same hospitalization). One-year mortality was 5.5%.


CONCLUSIONS
Left ventricular lead reimplantation is in our experience an effective and safe procedure, also in the case of right-sided approach. During follow-up, 1-year mortality was particularly low, whereas overall infection rate was higher than first implant procedures.
Department of Cardiovascular Diseases, University Hospital of Pisa, Via Roma 67, Pisa, Italy. zucchelli7@interfree.it
Giulio
G
Zucchelli
Maria Grazia
MG
Bongiorni
Andrea
A
Di Cori
Ezio
E
Soldati
Gianluca
G
Solarino
Iacopo
I
Fabiani
Luca
L
Segreti
Raffaele
R
De Lucia
Stefano
S
Viani
Giovanni
G
Coluccia
Luca
L
Paperini
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000401:mortality* / Q000517:prevention & control*; D058406:Cardiac Resynchronization Therapy / Q000706:statistics & numerical data*; D054326:Coronary Sinus / Q000601:surgery*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007221:Industry / Q000706:statistics & numerical data; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D019919:Prosthesis Implantation / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012086:Reoperation / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome