Coronary venous angioplasty to facilitate transvenous left ventricular lead placement: A single-center 13-year experience

Barriers to successful left ventricular lead placement within the coronary venous anatomy may include focal stenoses, thromboses, phrenic nerve stimulation, vessel tortuosity, small vessel caliber, nonexcitable tissue, and valve presence. A large series describing the utilization of coronary venous angioplasty (CVAP) for relief of these issues is absent in the literature.

We report our experience on all patients treated with CVAP in a single-center 13-year experience.

Forty-seven patients with CVAP (64% male, mean age 67 ± 12 years) were treated by five different implanting physicians for approved cardiac resynchronization therapy indications. The reason for CVAP was categorized by obstacle (focal occlusion, valve presence, small caliber vessel) and location. The number, type, and size of balloon used, inflation characteristics, complications, and success of lead deployment crossing the point of intervention were all tabulated.

Seventy-seven percent of patients (36/47) had successful CVAP. The most common reason for intervention was a focal occlusion (24/47; 51%), followed by valve presence (13/47; 28%), and small vessel caliber (10/47; 21%). Focal occlusions were most successfully managed with CVAP (23/24; 96%), followed by small vessel caliber (7/10; 70%) and valve presence (6/13; 46%). The reason for failure was most commonly due to failure to relieve the obstruction (5/11; 45%), thrombosis (3/11; 27.3%), dissection (2/11; 18.2%), and inability to pass the balloon through the occlusion (1/11; 9.0%). There were no significant complications developed from CVAP utilization.

In a large analysis, CVAP can be safely and successfully performed in the majority of instances required.