Biventricular Pacing for Congestive Heart Failure: Early Experience in Surgical Epicardial versus Coronary Sinus Lead Placement

2005 ◽  
Vol 6 (1) ◽  
pp. 1 ◽  
Author(s):  
Hironori Izutani ◽  
Kara J. Quan ◽  
Lee A. Biblo ◽  
Inderjit S. Gill
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Coronary Sinus ◽  
Biventricular Pacing ◽  
Nyha Class ◽  
Left Ventricular ◽  
Epicardial Lead ◽  
Lead Placement ◽  
Coronary Sinus Lead ◽  
Class Iv

<P>Objective: Biventricular pacing (BVP) has recently been introduced for the treatment of refractory congestive heart failure. Coronary sinus lead placement for left ventricular pacing is technically difficult, has a risk of lead dislodgement, and has long procedure times. Surgical epicardial lead placement has the potential advantage of the visual selection of an optimal pacing site, does not need exposure to ionic radiation, and allows lead multiplicity, but it does require a thoracotomy and general anesthesia. We report our early experience of BVP with both modalities. </P><P>Methods: BVP was performed in 12 patients with New York Heart Association (NYHA) class IV congestive heart failure (10 men, 2 women). Mean patient age was 68.7 years (range, 41-83 years). Surgical epicardial leads were placed through a 2- to 3-inch incision via a left fourth or fifth intercostal thoracotomy in 4 patients with single lung ventilation under general anesthesia. The other 8 patients underwent transvenous coronary sinus lead placement under conscious sedation. </P><P>Results: Postoperative NYHA class status improved from class IV to class II in 8 patients and to class III in 3 patients. In 5 of the 8 patients who had undergone follow-up echocardiography with mitral regurgitation, the severity of the mitral regurgitation improved. The mean left ventricular ejection fractions before and after BVP were 18.3% � 8.3% and 20.5% � 8.0%, respectively (P = .16). Mean fluoroscopy and total procedure times for transvenous lead placement were 77 � 19 minutes and 266 � 117 minutes, respectively. The mean surgery time for epicardial lead placement was 122 � 13 minutes. There were no differences between the 2 methods in pacing threshold or in lead dislodgement. There were no complications related to the surgery or the laboratory procedure. </P><P>Conclusion: In patients with NYHA class IV congestive heart failure, epicardial lead placement through a minithoracotomy for BVP was performed safely with benefits equivalent to those of coronary sinus lead placement and with a shorter procedure time.</P>

scholarly journals Surgical epicardial left ventricular lead versus coronary sinus lead placement in biventricular pacing☆

2005 ◽  
Vol 27 (2) ◽  
pp. 235-242 ◽  
Author(s):  
Helmut Mair ◽  
Joerg Sachweh ◽  
Bart Meuris ◽  
Georg Nollert ◽  
Michael Schmoeckel ◽  
...  
Keyword(s):  
Coronary Sinus ◽  
Biventricular Pacing ◽  
Left Ventricular ◽  
Left Ventricular Lead ◽  
Lead Placement ◽  
Ventricular Lead ◽  
Coronary Sinus Lead

Abstract 3071: Reversible Transmural Electrical Dyssynchrony in Pacing-Induced Congestive Heart Failure

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Nilesh Mathuria ◽  
Jianwen Wang ◽  
April L Gilbert ◽  
Daryl G Schulz ◽  
Mihir Naware ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Wall Thickness ◽  
Coronary Sinus ◽  
Electrical Conduction ◽  
Recovery Of Function ◽  
Conduction Delay ◽  
Conduction Time ◽  
Ventricular Dyssynchrony ◽  
Coronary Sinus Lead

Introduction: Inter and Intra-ventricular dyssynchrony can develop during congestive heart failure (CHF). We investigated transmural electrical conduction properties within the LV wall during CHF and subsequent recovery. Methods: Biventricular pacemakers were implanted in 8 normal mongrel dogs (mean weight: 38 kg), and continuous RV pacing (230 –250 bpm) was initiated to induce CHF. Echocardiography, catheterization, and LV myocardial biopsy were performed biweekly while pacing was temporarily stopped. At each catheterization, an intracardiac electrode-catheter was placed at the LV endocardium against the pacemaker coronary sinus lead tip located at the LV epicardium. Intrinsic transmural electrical conduction delay was measured by recording endocardial electrograms via the electrode-catheter and epicardial electrograms via the pacemaker coronary sinus lead, both in posterolateral LV. The conduction delay was also assessed during LV pacing via the endocardial catheter and measuring the time to the coronary sinus lead tip. Pacing was stopped in 4 dogs with CHF to allow for recovery of function. All times were corrected for heart rate. Results: All dogs developed CHF within 2– 4 wks of pacing from baseline (EF: 27±8 vs. 49±4%; LVEDP: 20±9 vs. 6±3 mmHg; QRS: 98±8 vs. 70±14 msec with no LBBB). There was no change in LV wall thickness during CHF compared to baseline (0.9 cm), while LV myocyte size increased (21.7±6.6 vs. 16.2±1.5 μm). Transmural endocardial-to-epicardial intrinsic electrical conduction time lengthened during CHF compared to baseline (35±13 vs. 10±5msec, P<0.001). In dogs recovering from CHF 2– 4 wks after cessation of pacing, intrinsic transmural endocardial-to-epicardial conduction time shortened compared to CHF (10±9 vs. 39±1ms, n=4), which was consistent with LV endocardial pacing (recovery: 47.5±6 ms; CHF: 70.7±9 ms, n=3). Conclusions: Electrical transmural dyssynchrony develops as a consequence of pacing-induced CHF, and is reversible upon recovery of cardiac function. These changes are not associated with LV wall thickness. This novel finding suggests another aspect of ventricular dyssynchrony that may not be reflected by routine noninvasive modalities and warrants further investigation.

Changing Strategies in the Management of Chronic Congestive Heart Failure

DICP ◽  
1991 ◽  
Vol 25 (12) ◽  
pp. 1349-1354 ◽  
Author(s):  
Daniel E. Hilleman ◽  
Syed M. Mohiuddin
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Mortality Rate ◽  
Heart Transplantation ◽  
Nyha Class ◽  
Class Ii ◽  
Left Ventricular ◽  
Fixed Dose ◽  
Chronic Congestive Heart Failure ◽  
Organ Systems

Recent studies have more clearly defined the role of drug therapy in patients with chronic congestive heart failure (CHF). Treatment of patients with asymptomatic left ventricular dysfunction (New York Heart Association [NYHA] class I) cannot be recommended at this time. The benefit of prophylactic treatment with angiotensin-converting enzyme inhibitors (ACEIs) or vasodilators in patients at high risk for developing symptomatic CHF is currently being evaluated. Treatment of patients with symptomatic CHF (NYHA class II-IV) should be initiated with a combination of a diuretic, digoxin, and an ACEI. This combination has been shown to reduce the mortality rate in patients with NYHA class II-IV CHF. Patients who remain symptomatic despite treatment with this combination may benefit from the addition of the direct-acting, nonspecific vasodilators—hydralazine and a nitrate. The addition of the nonspecific vasodilators to an ACEI has not been tested in controlled trials. In patients who remain symptomatic despite treatment with diuretics, digoxin, ACEIs, and nonspecific vasodilators, treatment options are not clear. The use of beta-agonists, phosphodiesterase inhibitors, and intermittent fixed-dose, fixed-interval dobutamine should be avoided as these agents are associated with a high mortality rate. Heart transplantation should be considered early in the course of CHF to allow for preservation of other vital organ systems. Unfortunately, heart transplantation is available to only a very small minority of potential transplant candidates.

Left Ventricular and Biventricular Pacing in Congestive Heart Failure

2001 ◽  
Vol 76 (8) ◽  
pp. 803-812 ◽  
Author(s):  
Thomas C. Gerber ◽  
Rick A. Nishimura ◽  
David R. Holmes ◽  
Margaret A. Lloyd ◽  
Kenton J. Zehr ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Biventricular Pacing ◽  
Left Ventricular

scholarly journals Cardiac resynchronization therapy system implantation complications

2021 ◽  
Vol 27 (3) ◽  
pp. 7-15
Author(s):  
Svetoslav Iovev ◽  
Peyo Zhivkov ◽  
Mariana Konteva
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Coronary Sinus ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Successful Therapy ◽  
Resynchronization Therapy ◽  
Established Method

Cardiac resynchronization therapy (CRT) using coronary sinus (CS) leads is an established method for the therapy of congestive heart failure (CHF) in the case of asynchronous ventricular contractions. Successful therapy depends on the placement of left ventricular leads usually via the coronary sinus (CS), a technically more challenging procedure than regular pacemaker implantations. Without specifi c precautions CRT implantation can be the gateway to a time-consuming nightmare. Therefore, CS lead implantation methods, with a focus on complications, were reviewed according to the literature and our own experience with approximately 4500 procedures from 2002-2021.

scholarly journals Left ventricular epicardial lead placement after Carillon placement in the coronary sinus

2019 ◽  
Vol 27 (10) ◽  
pp. 514-517
Author(s):  
C. A. da Fonseca ◽  
F. S. van den Brink ◽  
M. Feenema ◽  
K. Kraaier ◽  
T. N. Vossenberg
Keyword(s):  
Coronary Sinus ◽  
Left Ventricular ◽  
Epicardial Lead ◽  
Lead Placement

scholarly journals Improvement in pump function with endocardial biventricular pacing increases with activation time at the left ventricular pacing site in failing canine hearts

2011 ◽  
Vol 301 (4) ◽  
pp. H1447-H1455 ◽  
Author(s):  
Elliot J. Howard ◽  
James W. Covell ◽  
Lawrence J. Mulligan ◽  
Andrew D. McCulloch ◽  
Jeffrey H. Omens ◽  
...  
Keyword(s):  
Heart Failure ◽  
Biventricular Pacing ◽  
Pressure Change ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Activation Time ◽  
Lead Placement ◽  
Anterolateral Wall ◽  
The Right ◽  
Transmural Function

Recently, attention has been focused on comparing left ventricular (LV) endocardial (ENDO) with epicardial (EPI) pacing for cardiac resynchronization therapy. However, the effects of ENDO and EPI lead placement at multiple sites have not been studied in failing hearts. We hypothesized that differences in the improvement of ventricular function due to ENDO vs. EPI pacing in dyssynchronous (DYSS) heart failure may depend on the position of the LV lead in relation to the original activation pattern. In six nonfailing and six failing dogs, electrical DYSS was created by atrioventricular sequential pacing of the right ventricular apex. ENDO was compared with EPI biventricular pacing at five LV sites. In failing hearts, increases in the maximum rate of LV pressure change (dP/d t; r = 0.64), ejection fraction ( r = 0.49), and minimum dP/d t ( r = 0.51), relative to DYSS, were positively correlated ( P < 0.01) with activation time at the LV pacing site during ENDO but not EPI pacing. ENDO pacing at sites with longer activation delays led to greater improvements in hemodynamic parameters and was associated with an overall reduction in electrical DYSS compared with EPI pacing ( P < 0.05). These findings were qualitatively similar for nonfailing hearts. Improvement in hemodynamic function increased with activation time at the LV pacing site during ENDO but not EPI pacing. At the anterolateral wall, end-systolic transmural function was greater with local ENDO compared with EPI pacing. ENDO pacing and intrinsic activation delay may have important implications for management of DYSS heart failure.

scholarly journals 765 Is acute response to calcium sensitizers drugs predictive of response to cardiac contractility modulation in NYHA IV patients?

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Francesca Esposito ◽  
Paolo Vitillo ◽  
Francesco Urraro ◽  
Felice Nappi ◽  
Francesco Rotondi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Electronic Device ◽  
Enzyme Inhibitor ◽  
Nyha Class ◽  
Interventricular Septum ◽  
Left Ventricular ◽  
Calcium Handling ◽  
High Dose ◽  
Short Term Treatment ◽  
Class Iv

Abstract A 53-years old man presented to our institution with a diagnosis of decompensated heart failure NYHA Class IV. He had a history of ischaemic heart disease with severe biventricular dysfunction, diabetes, hypertension, dyslipidaemia, advanced chronic kidney disease, previous explanation of dual-chamber implantable electronic device (ICD) due to endocarditis and subsequent implantation of subcutaneous ICD in primary prevention. Home therapy included uptitrated angiotensin-converting enzyme inhibitor, β-blocker, loop-diuretic, spironolactone, acetylsalicylic acid, and oral hypoglycemics. Clinical examination showed signs and symptoms of systemic and pulmonary congestion with pleural effusion and ascites. Echocardiography revealed diffuse left ventricular (LV) hypokinesis with an ejection fraction (EF) of 25%, severe right ventricular dysfunction and increased filling pressures. He was treated with high dose of i.v. diuretics with mild improvement of dyspnoea. However, haemodynamic stability was labile with worsening of symptoms as soon as mild down-titration of iv diuretics was attempted. Levosimendan, a calcium-sensitizer inodilator, indicated for short-term treatment of acutely decompensated severe chronic heart failure (HF), was administered with good clinical response. Thus, we thought that the patient could have benefited from contractility modulation therapy (CCM) which acts on intramyocardial calcium handling. CCM is a novel therapeutic option for patients with classes III–IV HF with EF ≥ 25% to ≤ 45% and narrow QRS complex that acts on intramyocardial calcium-handling. CCM proved effective in alleviating symptoms, improving exercise tolerance and quality of life, and reducing hospitalization rates in HF. It improves myocardial contractility, reverses the foetal myocyte gene program associated with HF and facilitates cardiac reverse remodelling. Therefore, an Optimizer Smart System (Impulse Dynamics) was implanted. Two pacing electrodes were placed on the interventricular septum in apical and mid-septal position, respectively. The leads were connected to a pulse-generator in a right pectoral pocket. In the following days, we observed a progressive improvement in clinical status, with gradual resolution of peripheral oedema, dyspnoea and fatigue and significant weight loss. Six-month echocardiography showed a stable value of EF and significant improvement in stroke volume (35.2 ml from 24.8 ml at baseline). The patient did not undergo further hospitalization for decompensated HF and was in stable ambulatory NYHA Class IV. We believe CCM is an option in patients with advanced HF in which avoiding recurrent hospitalizations, with their overt increase mortality, is often a challenging therapeutic goal. 765 Figure

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