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Hemodynamic collapse during left ventricular lead implantation
Sujeeth R Punnam1, Jeffrey Holiday, Renee Janes
1Department of Internal Medicine, Division of Cardiology, Michigan State University, Sparrow Health System, Thoracic and Cardiovascular Institute, Lansing, Michigan 48910, USA.
Insights
Hypotension during cardiac resynchronization therapy (CRT) implantation is a rare but serious complication. This study identifies patient factors and procedural events associated with severe hypotension during CRT procedures.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Trials
Background:
- Procedural hypotension during cardiac resynchronization therapy (CRT) implantation is an infrequent complication.
- Limited data exists on the characteristics and contributing factors of this hemodynamic instability.
Observation:
- A review of 105 CRT implantations identified four patients experiencing severe hypotension (systolic blood pressure <= 50 mmHg).
- These patients commonly had hypertension, diabetes mellitus, pacemaker dependency, and reduced left ventricular ejection fraction (< or =20%).
- Hypotension occurred during coronary sinus cannulation or left ventricular pacing.
Findings:
- Severe hypotension during CRT implantation is associated with specific patient comorbidities and procedural stages.
- Mechanisms of hemodynamic collapse, distinct from cardiac tamponade, require further investigation.
Implications:
- Understanding these associations can help clinicians anticipate and potentially mitigate hypotension during CRT procedures.
- Further research into the mechanisms of hypotension is warranted to improve patient safety during CRT implantation.
Abstract:
Hypotension as a procedural complication during cardiac resynchronization therapy (CRT) implantation was reported in the initial randomized clinical trials. However, this phenomenon is not well characterized. We reviewed our CRT implantation experience to better understand this issue. There were 105 patients who underwent left ventricular lead implantation for CRT. Four patients had marked hypotension (systolic blood pressure < or = 50 mmHg) during the procedure. All had a history of hypertension and diabetes mellitus and were pacemaker dependent. Two had normal renal function, one had moderate renal insufficiency, and one was on dialysis. Three patients had ischemic cardiomyopathy. All had left ventricular ejection fraction < or =20% and were in New York Heart Association class III. Propofol and midazolam were used for sedation as standard protocol. Two patients had sudden hypotension when the coronary sinus was being cannulated, and two patients experienced sudden hypotension during left ventricular pacing. Cardiac tamponade as a possible cause was ruled out by echocardiography. We discuss possible mechanisms of sudden hemodynamic collapse during CRT implantation.
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