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How can we improve the success of cardiac resynchronization therapy implantation?
Session:
CO10 - Arritmologia
Speaker:
Afonso Nunes Ferreira
Congress:
CPC 2019
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Afonso Nunes Ferreira; Pedro Silvério António; Inês Aguiar Ricardo; João Pedro Ribeiro Agostinho; Joana Rigueira; Rafael Santos; Tiago Graça Rodrigues; Nelson P. Cunha; Ana Bernardes; Fausto José Pinto; João Rodrigues De Sousa; Pedro Nuno Carlos Marques
Abstract
<p><u>Introduction</u>:</p> <p>The left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) is one of the most important and complex steps, leading to implantation failure in 10-15% of cases. New LV lead implantation techniques are needed to improve resynchronization and decrease mortality and hospitalizations.</p> <p> </p> <p><u>Objectives</u>:<br /> To evaluate the efficacy and safety of the snare technique in the LV lead implantation in cases of standard technique failure.</p> <p> </p> <p><u>Methods</u>:</p> <p>Prospective, unicentric study of patients undergoing CRT implantation since 2015. Demographic, clinical, and CRT implantation techniques were evaluated, taking into account the vessel with the best resynchronization capacity. The snare technique, through the active traction of the lead to the target vessel, was used in cases of standard technique failure. Time to surgical revision and mortality were evaluated by the Cox regression and Kaplan-Meier methods. Major complications, defined as reasons for prolonged hospitalization or potentially fatal, were evaluated.</p> <p> </p> <p><u>Results</u>:</p> <p>486 CRTs were implanted since 2015 (73.9% males, 73 years (IQR 66-79), median follow-up of 487 days (IQR 175-749), 91% for heart failure, dilated cardiomyopathy in 55.4%. In 17.3% of these patients (n = 84), LV lead was implanted through the snare technique, 94% of the cases in a lateral vein, 100% efficacy in the positioning in the intended vessel.</p> <p>Comparing the snare technique with the standard technique, patients implanted with snare presented a lower all-cause surgical revision (HR 0.31, 95% CI 0.094-0.98, p = 0.035), with a number needed to treat of 25 patients to prevent one surgical revision, and a lower revision rate due to LV lead implant failure/dislodgement (Log Rank 5.1, p = 0.024). There were no surgical revisions for LV lead repositioning in patients undergoing the snare technique. The rate of major complications (4.8% vs 3.0%, p = 0.41), 30-day mortality (3.5% vs 1.8%, p = 0.28) and all-cause mortality (13.1% vs 13.9%, p = 0.47) were similar to the standard procedure. Major complications in both groups were pericardial effusion and contrast nephropathy.</p> <p>The snare technique presented a longer procedure duration (104 vs 78 min, p <0.01) and fluoroscopy time (26.6 vs 15.5 min, p < 0.01). There has been a learning curve with reduction in the duration of procedure and fluoroscopy.</p> <p> </p> <p><u>Conclusion</u>:</p> <p>The snare technique allows LV lead implantation in the vein with the best resynchronization characteristics, increasing the success rate in the implantation of CRT.</p> <p>It also reduced all-cause surgical revisions and surgical revisions due to LV lead implant failure/dislodgement, with a favorable safety profile similar to the standard technique.</p>
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