ABSTRACT
Coronary sinus (CS) lead positioning is one of the main determinants of cardiac resynchronization therapy (CRT). The implantation of the CS lead is faced with several technical difficulties that may prevent the achievement of a stable position and good performance of the CS lead without phrenic nerve stimulation (PNS). New developments in catheter and lead technology to overcome these difficulties are presented.
Subject(s)
Biotechnology/trends , Cardiac Resynchronization Therapy Devices , Cardiac Resynchronization Therapy/trends , Electrodes, Implanted , Heart Failure/prevention & control , Prosthesis Implantation/methods , Forecasting , HumansABSTRACT
Since the introduction of transvenous left ventricular lead systems nearly a decade ago, resynchronization therapy has gained widespread acceptance and has become a growing field in heart failure therapy. Due to the increasing numbers of implanting centers and physicians, the need for adequate education is increasing. This article describes and illustrates the anatomical background, the technical opportunities and pitfalls, which have to be overcome, to achieve an implanting success rate of 95% to 98%, as can be achieved by well-trained physicians under optimal conditions.
Subject(s)
Cardiac Resynchronization Therapy Devices , Electrodes, Implanted , Heart Failure/prevention & control , Prosthesis Implantation/methods , Germany , HumansABSTRACT
Upgrading RV pacing systems to biventricular resynchronization modalities is a promising option for paced patients with worsening heart failure. The potentially favorable effect of upgrading has been demonstrated in several, non-randomized trials. Selection of eligible patients and technical aspects of the procedure are described. The most common procedure-related complications are reported.
Subject(s)
Cardiac Pacing, Artificial/mortality , Heart Failure/mortality , Heart Failure/prevention & control , Quality Assurance, Health Care/methods , Risk Assessment/methods , Ventricular Dysfunction, Right/mortality , Ventricular Dysfunction, Right/prevention & control , Humans , Incidence , Risk FactorsABSTRACT
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.
