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Different venous angioplasty manoeuvres for successful implantation of CRT devices
Guido Luedorff1, Rainer Grove, Wolfgang Kranig
1Department of Cardiology, Schuechtermann-Klinik, Heart Center Osnabrueck-Bad Rothenfelde, Ulmenallee 11, Bad Rothenfelde, Germany. g.luedorff@schuechtermann-klink.de
Insights
Venous angioplasty is a safe and effective technique to overcome venous stenosis and ensure successful cardiac resynchronization therapy (CRT) lead placement in patients with severe heart failure.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Device Technology
Background:
- Cardiac resynchronization therapy (CRT) is increasingly used for severe heart failure.
- Venous stenosis, complex coronary sinus anatomy, and subclavian vein occlusions can impede CRT lead placement.
Purpose of the Study:
- To evaluate the impact of venous angioplasty on successful left ventricular (LV) lead placement in CRT procedures.
- To assess the safety and efficacy of angioplasty for challenging venous anatomies.
Main Methods:
- Retrospective analysis of 705 CRT implantation procedures (1999-2007).
- Venous angioplasty performed in 31 patients (3.5%) for LV lead placement, dilating coronary veins, subclavian veins, coronary sinus valves, and the Marshall vein.
- Utilized balloons (2.5-4.0 mm) with high inflation pressures (16 +/- 4 atm) for ring-like strictures.
Main Results:
- Successful LV lead placement achieved in 99% of cases following angioplasty.
- Angioplasty was performed on coronary veins (n=24), subclavian veins (n=4), coronary sinus valves (n=3), and Marshall vein (n=1).
- Complications associated with the angioplasty procedures were rare.
Conclusions:
- Venous angioplasty is a valuable and safe adjunct for achieving successful CRT lead placement in challenging venous anatomies.
- Balloon angioplasty, particularly with 3.0mm balloons, facilitates the implantation of at least unipolar leads.
- This technique expands CRT candidacy for patients with previously prohibitive venous obstructions.
Aims:
Cardiac resynchronization therapy (CRT) has growing impact in the treatment of severe heart failure Stenosis of coronary veins, complex structure of coronary sinus and occlusions of subclavian veins can limit lead passage in the target vein.
Methods And Results:
Retrospective analysis of 705 implantation procedures of CRT devices from 1999 to July 2007 in a single centre to show the impact of venous angioplasty manoeuvres for successful placement of left ventricular lead. In 31 patients (3.5%) venous angioplasty was performed for LV-lead placement: 24 coronary veins (balloons 2.5-4.0 mm), 4 subclavian veins, 3 valves in the coronary sinus and one Marshall vein were dilated. Ring like strictures of coronary veins made high inflation pressures (16 +/- 4 atm) necessary. Success rate of LV lead placement were 99%. Complications were rare.
Conclusions:
Angioplasty of coronary or subclavian veins and valve structures of coronary sinus are a useful and safe tool for successful lead placement. The use of balloons of 3.0mm in size usually allows implantation of at least a unipolar lead.
