Cardiac venous injuries: Procedural profiles and outcomes during left ventricular lead placement for cardiac
Johnny Chahine1, Bryan Baranowski2, Khaldoun Tarakji2
1Department of Medicine, Cleveland Clinic, Cleveland, Ohio.
Insights
Coronary sinus injury during cardiac resynchronization therapy (CRT) is uncommon. While it can complicate lead placement, successful outcomes are achievable in most patients, though morbidity may increase.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Procedures
Background:
- Cardiac venous structure injury can complicate left ventricular lead placement for cardiac resynchronization therapy (CRT).
- Outcomes of coronary sinus (CS) dissection, with or without perforation, are not well-understood.
Purpose of the Study:
- To determine the outcomes in patients experiencing coronary sinus (CS) injury during cardiac resynchronization therapy (CRT) implantation.
Main Methods:
- A prospectively maintained registry of CRT procedures (2001-2018) at Cleveland Clinic was reviewed.
- Patients with cardiac venous injuries during CRT implantation were identified and their outcomes analyzed.
Main Results:
- Coronary sinus (CS) injury occurred in 0.7% of patients (35/5011), with 17.1% involving perforation.
- Successful CS lead placement post-dissection was 72.4% without perforation and 16.7% with perforation.
- Overall, 65.7% achieved lead placement during the index procedure, with others undergoing subsequent procedures or receiving epicardial leads.
Conclusions:
- Coronary sinus (CS) injury during CRT implantation is infrequent and does not invariably preclude successful lead placement.
- While mortality is low, CS injury is associated with increased patient morbidity.
- Successful lead placement can be achieved in a significant majority of patients experiencing CS injury.
Background:
Injury to the cardiac venous structures can complicate left ventricular lead placement for cardiac resynchronization therapy (CRT). Little is known about the outcomes of coronary sinus (CS) dissection with or without perforation.
Objective:
The purpose of this study was to determine the outcomes in patients who had a CS injury during CRT implantation.
Methods:
All patients undergoing procedures for CRT implantation at the Cleveland Clinic (2001-2018) were enrolled in a prospectively maintained registry for procedural profiles and complications. All patients with cardiac venous injuries during the procedures were included.
Results:
CS injury occurred in 35 of 5011 patients (0.7%; 6 perforations (17.1%), 29 dissections without perforation (82.9%)). In patients with dissection in the absence of perforation, attempts at CS lead placement after dissection were successful in 21 of 29 patients (72.4%). In those with perforation (n=6, 17.1%), CS lead placement was successful in one of them (16.7%). Cardiac tamponade occurred in 2 patients (5.7%), and the procedure was aborted in both of them. Overall, CS lead placement failed in 13 patients (37%) but 9 (25.7%) underwent subsequent CRT with CS lead placement (n=6, 17.1%; median 58 days later) or epicardial leads (n=3, 8.6%). Three of the remaining 4 patients (8.6%) refused to undergo further procedures, and the fourth (2.9%) died of a complicated course.
Conclusion:
CS injury is not common during CRT implantation procedures and did not preclude successful lead placement in 23 of 35 patients (65.7%) during the index procedure and 6 of 6 (100%) during the subsequent attempted procedures. A low rate of mortality was observed in such patients, but CS injury was associated with increased morbidity.
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