title: Impact of using a telescoping-support catheter system for left ventricular lead placement on implant success and procedure time of cardiac resynchronization therapy.
abstract: BACKGROUND
  Proper positioning of the left ventricular (LV) lead improves clinical outcomes and survival in patients receiving cardiac resynchronization therapy (CRT). Techniques of LV lead insertion using contrast injection and a telescoping system of delivery catheters to support advancement of the lead into the target branch may allow more efficient, targeted lead placement. We sought to evaluate the impact of an LV lead implant approach using telescoping-support catheters (group TS) on success rate, lead location, and procedural time compared to standard over-the-wire implant techniques (group OTW).
  
  
  METHODS
  Four hundred thirty-seven consecutive patients undergoing CRT implantation were divided into group TS (n = 105) or group OTW (n = 332) based upon a review of the operative technique used for LV lead implantation. The primary outcome was success of LV lead implantation at the index procedure. Secondary endpoints included optimal positioning of the LV lead and reduction in procedural fluoroscopy time.
  
  
  RESULTS
  Failed LV lead placement was lower (1.9% vs 8.1%, P = 0.02) and optimal lead positioning was achieved more often for group TS than group OTW (87% vs 75%, P = 0.01). In addition, there were significantly shorter fluoroscopy times for group TS versus group OTW (29.6 minutes vs 41.9 minutes, P < 0.01).
  
  
  CONCLUSIONS
  A CRT-implant approach using contrast injection and a telescoping-support catheter system results in fewer failed LV lead implants, improved LV lead location, and shorter procedure times.
authors: Division of Clinical Cardiac Electrophysiology, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA. k.j@duke.edu
authors: Kevin P
authors: KP
authors: Jackson
authors: Donald D
authors: DD
authors: Hegland
authors: Camille
authors: C
authors: Frazier-Mills
authors: Jonathan P
authors: JP
authors: Piccini
authors: Jason I
authors: JI
authors: Koontz
authors: Brett D
authors: BD
authors: Atwater
authors: James P
authors: JP
authors: Daubert
authors: Seth J
authors: SJ
authors: Worley
mesh_terms: D000368:Aged; D062906:Cardiac Catheters / Q000706:statistics & numerical data*; D058409:Cardiac Resynchronization Therapy Devices / Q000706:statistics & numerical data*; D004567:Electrodes, Implanted / Q000706:statistics & numerical data*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006333:Heart Failure / Q000453:epidemiology* / Q000517:prevention & control*; D006352:Heart Ventricles / Q000601:surgery; D006801:Humans; D008297:Male; D009657:North Carolina; D061646:Operative Time; D015995:Prevalence; D019919:Prosthesis Implantation / Q000295:instrumentation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D016526:Workload / Q000706:statistics & numerical data*