ABSTRACT
Cardiac contractility modulation (CCM) is a treatment option for patients with systolic ventricular dysfunction, independent of QRS duration, moderate to severe systolic heart failure and symptoms despite optimal medical therapy. In contrast to cardiac resynchronization therapy (CRT) which has been an established therapy in patients with wide QRS and ventricular asynchrony, CCM can enhance cardiac contractility in patients independent of QRS duration. Whereas inotropic drugs increase oxygen demand, CCM works without additional myocardial oxygen need and without reference to asynchrony. Non-excitatory signals applied during the absolute refractory period have been shown to enhance the strength of left ventricular contraction in animals and humans with heart failure probably due to normalization of myocardial gene expression. Several multicenter studies have demonstrated safety and efficacy of CCM in patients with medically refractory heart failure. We describe the specific technical aspects and conditions in clinical application of CCM.
Subject(s)
Cardiac Pacing, Artificial/methods , Heart Failure/prevention & control , Heart Failure/physiopathology , Myocardial Contraction , Therapy, Computer-Assisted/methods , Ventricular Dysfunction, Left/prevention & control , Ventricular Dysfunction, Left/physiopathology , Animals , Heart Failure/etiology , Humans , Treatment Outcome , Ventricular Dysfunction, Left/complicationsABSTRACT
Percutaneous coronary intervention (PCI) has been increasingly applied to patients with severely depressed left ventricular function and complex coronary lesions. The availability of hemodynamic support devices offers a promising option to reduce PCI-related complications in high-risk procedures. We report the case of a 79-year-old man who suffered from unstable angina. The coronary angiogram revealed multivessel disease including a significant distal left main (LM) stenosis. Additionally, the patient had a history of chronic lymphatic leukemia with immune hemolysis. Therefore, the patient was considered to be at exceptionally high mortality risk in case of cardiac surgery. We decided to perform a percutaneous revascularization of the LM supported by the Impella Recover LP 2.5 assist device. This case report discusses the principles of indications, technique and complications of this new addition to interventional cardiology.
Subject(s)
Blood Vessel Prosthesis , Coronary Stenosis/therapy , Heart-Assist Devices , Prosthesis Implantation/instrumentation , Prosthesis Implantation/methods , Stents , Aged , Combined Modality Therapy , Humans , Male , Treatment OutcomeABSTRACT
Biventricular pacing system implantation is a challenging procedure. The first-choice technique to initiate left ventricular pacing consists of a transvenous approach via the coronary sinus (CS) tributaries. Different techniques to achieve CS access using dedicated guiding catheters and left ventricular leads are described. New developments in catheter and lead technology are presented. The most common procedure-related complications are reported.
