scholarly journals A Hybrid Procedure Combining Mini-Thoracotomy with Interventional Endocardial Lead Implantation for Cardiac Resynchronization Therapy in Patients with Chronic Congestive Heart Failure: A Report of Four Cases

2020 ◽  
Vol 23 (5) ◽  
pp. E627-E631
Author(s):  
Haiyan Xiang ◽  
Rifeng Gao ◽  
Juesheng Yang ◽  
Juxiang Li ◽  
Jin Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Nerve Stimulation ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Chronic Congestive Heart Failure ◽  
Electrode Impedance ◽  
Resynchronization Therapy ◽  
Mini Thoracotomy

Background: We describe the application and effectiveness of transthoracic electrode implantation for epicardial left ventricular pacing in cardiac resynchronization therapy (CRT) for patients with chronic congestive heart failure. Methods: We assessed four patients with chronic congestive heart failure for whom implantation of endocardial electrodes was contraindicated. The epicardial electrodes were implanted via a mini-thoracotomy in the fourth or fifth left intercostal space. We analyzed the surgical implantation technique and the short-term effectiveness of the procedure. Results: The epicardial electrodes successfully were implanted in all four patients. The patients’ hemodynamic status, cardiac function, and symptoms significantly improved. Patients I, II, III, and IV were discharged from the hospital on the 8, 11, 4, and 7 days, respectively, after the operation. Follow up lasted for 12 months. None of the patients presented with electrode fractures or surgical wound infections, and the pacing threshold and electrode impedance were normal. In one case, phrenic nerve stimulation occurred due to the low placement position of the electrode. When the electrode was moved slightly inward and upward, the sacral nerve stimulation sign disappeared, and no other complications were noted. One patient developed capsule infection, and the presence of an ectopic pacemaker was noted; therefore, a pacemaker replacement procedure was required. Conclusion: In CRT, the implantation of a left ventricular epicardial electrode through a left-sided small incision is safe, feasible, and effective. This hybrid surgery combining interventional and cardiac techniques can maximize the curative effect of CRT.

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.

Predictors of 5-year mortality in patients with congestive heart failure and implanted devices for cardiac resynchronization therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Soldatova ◽  
V.A Kuznetsov ◽  
S.M Dyachkov
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Congestive Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Left Ventricular Ejection ◽  
Resynchronization Therapy ◽  
Therapeutic Benefits ◽  
Wide Range

Abstract   Cardiac resynchronization therapy (CRT) has a wide range of therapeutic benefits including reduction in hospitalizations and death in appropriately selected patients, while the appropriate selection remains the cornerstone of CRT. Apart from the current selection criteria, many additional factors may play an incremental role affecting cardiac prognosis and CRT efficacy. Aim To examine the ability of a multiparametric score to predict 5-year mortality in patients with congestive heart failure (HF) treated with CRT. Methods The study enrolled 218 HF patients (83% men, 17% women; mean age of 58.7±10.7 years) with left ventricular ejection fraction (LVEF) ≤35%, NYHA class II-IV. 130 patients (59.6%) had ischemic etiology of HF (84 with prior myocardial infarction), 88 patients (31.4%) – non-ischemic cardiomyopathy. 57.3% of patients had left bundle branch block (LBBB), mean QRS width was 150.5±38.4 ms. Results The mean follow-up period was 38.8±20.9 months. The 5-year survival was 69.3%. Points were calculated from 11 parameters identified as factors associated with all-cause mortality in multivariate analysis: gender (female – 0, male – 1); etiology of HF (non-ischemic – 0, ischemic – 1); history of myocardial infarction (no – 0, yes – 1); NYHA (II or III – 0, IV – 1); QRS (≥150 ms or ≤120 ms + 3 parameters of mechanical dyssynchrony – 0, 120–149 ms – 1); rhythm (sinus or radiofrequency ablation of atrial fibrillation (AF) – 0, AF – 1); LBBB (LBBB – 0, non-LBBB – 1); LVEF (>30% – 0, ≤30% – 1); frailty (not frail – 0, frail – 1); PR interval (<200 ms – 0; ≥200 ms – 1); NT-proBNP (median value) (<1788 pg/ml – 0, ≥1788 pg/ml – 1). To calculate the score, the sum of points was divided by the number of parameters. If less than 3 items were missing the denominator adjusted accordingly. The 5-year survival rate for patients with highest tertile score (>0.44; n=43) was 43.1%, for middle tertile (0.44≤ score ≥0.22; n=124) – 73.4% and 88.4% for lowest tertile (<0.22; n=51) (Log rank p<0.001). Conclusions Multiparametric score can be used to predict 5-year mortality in patients with CRT. Survival curves in groups by tertiles Funding Acknowledgement Type of funding source: None

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