Left ventricular lead stabilization to retain cardiac resynchronization therapy at long term: when is it advisable?
OBJECTIVE
Left ventricular (LV) lead dislodgement occurs in about 10.6% of patients in the first 12 months after cardiac resynchronization therapy defibrillator implantation, and causes lack of clinical improvement, repeated surgery, and predisposes to infective complications and death. To understand the factors predictive of lead dislodgement, and to investigate whether bipolar LV lead stabilization can reduce the dislodgement rate and improve the clinical outcome.


RESULTS
Predisposing coronary vein anatomy was identified on a retrospective series of 218 patients implanted before August 2009. Lead stabilization guided by vein anatomy was prospectively tested on consecutive patients from October 2009 to December 2010. Among 84 patients, lead stabilization based on vein anatomy was recommended in 19 patients, of which 16 agreed and 3 refused. Two of these latter had lead dislodgement within 1 month, whereas none of the former had adverse events during 23.8 ± 3.1 months follow-up. Only 1 of 58 patients deemed at low risk had lead dislodgement. Seven patients required lead stabilization for severe phrenic stimulation issues that dictated lead placement at specific sites. Patients with stabilized LV leads were more likely to be cardiac resynchronization therapy (CRT) responders than the others: 19 of 26 (73%) vs. 34 of 58 (59%, P= NS), and had a significantly higher proportion of super-responders: 12 of 26 (46%) vs. 12 of 58 (21%, P< 0.005).


CONCLUSIONS
Coronary vein anatomy may assist decision making about the need for LV lead stabilization, and the choice of tools during the implanting procedure to ensure effective CRT delivery at long term.
Institute of Cardiology, Policlinico S. Orsola-Malpighi, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
Mauro
M
Biffi
Matteo
M
Bertini
Matteo
M
Ziacchi
Igor
I
Diemberger
Cristian
C
Martignani
Giuseppe
G
Boriani
D000368:Aged; D000369:Aged, 80 and over; D006328:Cardiac Catheterization / Q000295:instrumentation; D058406:Cardiac Resynchronization Therapy; D058409:Cardiac Resynchronization Therapy Devices; D017023:Coronary Angiography; D054326:Coronary Sinus / Q000000981:diagnostic imaging*; D004867:Equipment Design; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left
Cardiac resynchronization therapy; Heart failure; Lead dislodgement; Lead stabilization