Mid-term follow up of thromboembolic complications in left ventricular endocardial cardiac resynchronization therapy.
BACKGROUND
Endocardial left ventricular (LV) pacing for cardiac resynchronization therapy (CRT) has been proposed as an alternative to traditional LV transvenous epicardial pacing with equal or superior cardiac performance. The risks of cerebral thromboembolism and possible interference with mitral valve function moderate its clinical application.


OBJECTIVE
The purpose of this study was to investigate cerebral thromboembolic complications after LV endocardial lead placement. Mitral regurgitation (MR) was the secondary outcome measure.


METHODS
CRT candidates with a failed coronary sinus approach or nonresponders to conventional CRT underwent endocardial LV lead implantation (45 atrial transseptal, 6 transapical). Coumarin was prescribed with a targeted international normalized ratio between 3.5 and 4.5. Patient records were checked and general practitioners were contacted regarding cerebral thromboembolic complications. MR was evaluated by echocardiography at baseline and after 6 months.


RESULTS
In 7 patients, 6 ischemic strokes and 2 transient ischemic attacks occurred, corresponding to 6.1 thromboembolic events per 100 patient-years (95% confidence interval 3.4-15.8). One patient refused hospital admission; all other patients had a subtherapeutic anticoagulation level at the time of the event. No major bleeding complications occurred. There was no change in the grade of MR (grade 2, P = .727) after 6 months.


CONCLUSIONS
Endocardial LV lead placement in patients with advanced heart failure is associated with thromboembolic risk. However, all but 1 patient had a subtherapeutic level of anticoagulation. Endocardial LV lead placement is not associated with aggravation of MR.
Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. Electronic address: nard.rademakers@cze.nl.
Leonard M
LM
Rademakers
Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Berry M
BM
van Gelder
Department of Cardiology, Reinier de Graaf Hospital, Delft, The Netherlands.
Mike G
MG
Scheffer
Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
Frank A
FA
Bracke
D000368:Aged; D058406:Cardiac Resynchronization Therapy / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy; D006352:Heart Ventricles; D006801:Humans; D020766:Intracranial Embolism / Q000209:etiology*; D020767:Intracranial Thrombosis / Q000209:etiology*; D008297:Male
Cardiac resynchronization therapy; Cerebrovascular accident; Endocardial left ventricular lead placement; Stroke; Thromboembolic risks