title: Transseptal Leftventricular Endocardial Pacing is an Alternative Technique in Cardiac Resynchronization Therapy. One Year Experience in a High Volume Center.
abstract: BACKGROUND
  In patients receiving cardiac resynchronization therapy (CRT), failure rate to implant the left ventricular (LV) lead by the traditional trans-venous approach is 4-8%. Surgical epicardial implantation is considered as an alternative, but this technique is not without morbidity. Evidence from case documentation and from small trial batches demonstrated the viability of endocardial LV lead implantation where surgical epicardial lead placement is not applicable.
  
  
  METHODS
  Four patients were implanted with endocardial LV lead using the transseptal atrial approach after unsuccessful transvenous implantation. Implantation of an endocardial active fixation LV leads was successful in all patients with stable electrical parameters immediately after implantation and over the follow-up period. All patients received anticoagulation therapy in order to target the international normalized ratio of 2.5-3.5 and have not experienced any thromboembolic, hemorrhagic events, or infection.
  
  
  RESULTS
  Follow-up echocardiography indicated significant improvement of LV systolic function (24 + 4.9 to 32 + 5.1 %, P = 0.023) with a notable improvement of the functional status.
  
  
  CONCLUSIONS
  Endocardial left ventricular lead implantation can be a valuable and safe alternative technique to enable LV stimulation in high surgical risk patients where standard coronary sinus implant is unsuccessful.
authors.forename: I
authors.initials: I
authors.lastname: Neuhoff
authors.forename: S
authors.initials: S
authors.lastname: Szilágyi
authors.forename: L
authors.initials: L
authors.lastname: Molnár
authors.forename: I
authors.initials: I
authors.lastname: Osztheimer
authors.forename: E
authors.initials: E
authors.lastname: Zima
authors.forename: G A
authors.initials: GA
authors.lastname: Dan
authors.forename: B
authors.initials: B
authors.lastname: Merkely
authors.forename: L
authors.initials: L
authors.lastname: Gellér
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage; D058406:Cardiac Resynchronization Therapy / Q000379:methods; D058409:Cardiac Resynchronization Therapy Devices; D004567:Electrodes, Implanted; D004699:Endocardium / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000628:therapy; D061847:Hospitals, High-Volume; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods; D012189:Retrospective Studies; D012383:Romania; D016896:Treatment Outcome; D054088:Ventricular Septum / Q000601:surgery*
chemical_list: D000925:Anticoagulants