Long-term experience with coronary sinus side branch stenting to stabilize left ventricular electrode position

Area of Science:

• Cardiology
• Medical Devices
• Interventional Electrophysiology

Background:

• Coronary sinus (CS) lead implantation presents challenges, with lead dislocation remaining a significant clinical issue.
• Technical advancements have not fully resolved the problem of CS lead dislodgement.

Purpose of the Study:

• To evaluate the effectiveness and safety of using stent implantation to secure CS leads.
• To assess the long-term outcomes of anchoring leads to the CS side branch wall with stents.

Main Methods:

• A bare metal coronary stent was deployed in the CS side branch of 312 patients.
• Stenting was performed for lead dislocation (16 patients) or unstable position/phrenic nerve stimulation (296 patients).
• Stents were placed 5-35 mm proximal to the most proximal electrode, with no observed mechanical damage or effusion.

Main Results:

• Low rates of reoperation (0.6%) and clinically significant pacing threshold increase (4 cases) were observed.
• Phrenic nerve stimulation occurred in 18 instances, managed with repositioning in seven.
• Lead extraction due to infection or during heart transplantation showed no complications.

Conclusions:

• Stent implantation is an effective and safe method for stabilizing CS lead position.
• The procedure aids in both preventing and treating CS lead dislocation in appropriately selected patients.