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Coronary Sinus Reducer Implantation in a Patient With Pre-Existing Left Ventricular Lead
Azhar Farooqui1, F Aaysha Cader1, Prashanth Raju1
1Department of Cardiology, Kettering General Hospital, Kettering, United Kingdom.
Insights
Coronary sinus reducer (CSR) implantation is feasible in patients with existing left ventricular (LV) leads. However, potential challenges with future lead extraction and long-term device performance require further investigation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Coronary sinus reducer (CSR) implantation is a novel therapy for refractory angina.
- Indications for cardiac resynchronization therapy (CRT) are expanding.
- Safety data for CSR implantation in patients with prior left ventricular (LV) leads are limited.
Observation:
- A case report details the successful implantation of a CSR device in a 79-year-old patient with ischemic cardiomyopathy and a pre-existing LV lead.
- The patient presented with symptoms of refractory angina.
Findings:
- CSR implantation in the presence of an LV lead is technically feasible.
- Potential for LV lead trapping between the CSR stent and coronary sinus exists, potentially complicating future lead extraction.
- Long-term effects of LV leads on CSR endothelialization and device failure rates are unknown.
Implications:
- This case highlights the feasibility of CSR implantation in patients with prior LV leads.
- Further research is needed to assess the long-term safety and efficacy of CSR in this patient population.
- Consideration of potential lead-device interactions is crucial for procedural planning and patient management.
Background:
Coronary sinus reducer (CSR) implantation is a novel therapeutic modality for patients with refractory angina and no targets for invasive coronary intervention. With expanding indications for cardiac resynchronization therapy, data related to safety of CSR implantation in patients with prior left ventricular (LV) lead are scarce.
Case Summary:
We report the successful implant of a CSR device in the coronary sinus of a 79-year-old patient with a pre-existing LV lead with ischemic cardiomyopathy referred for symptoms of refractory angina.
Discussion:
LV lead failure can lead to the reemergence of symptoms of heart failure warranting lead removal and reimplantation. Trapping of the LV lead between the CSR stent and the coronary sinus may make future lead extractions challenging.
Take-Home Message:
CSR implantation in the presence of LV lead is feasible; however, long-term data are required regarding whether the presence of the LV lead effects CSR endothelialization or subsequent device failure rate.
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