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The potential benefit of the epicardial left ventricular lead in ischemic cardiomiopathy
Session:
Sessão de Comunicações Orais - Doença Coronária
Speaker:
Tamara Pereira
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.4 Coronary Artery Disease – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Tamara Pereira; Bebiana Faria; Pedro Von Hafe Leite; Geraldo Dias; Ana Filipa Cardoso; Sérgio Leite; Francisco Castro Ferreira; Victor Manuel Sanfins; António Lourenço
Abstract
<p><strong>Background: </strong>Transvenous coronary sinus leads is the most common approach for cardiac resynchronization therapy (CRT). However, this approach is not possible in a substantial proportion of patients and epicardial leads (EPL), which allows the identification of the best myocardial location to pacing by avoiding fibrotic areas, are an alternative. In this analysis we aimed to access whether these two therapies lead to different outcomes regarding left ventricular ejection fraction (LVEF).</p> <p><strong>Methods</strong>: We performed a retrospective, single-center study of 143 patients undergoing CRT implantation between 2013 and 2017 according to the current guidelines indications. Clinical, electrocardiographic and echocardiographic parameters were evaluated.</p> <p>Results: A total of 143 patients underwent CRT implantation in our center since between 2013 and 2017. Of these a total of 59 patients were included in our analysis, from whom all data were available, and these represent our sample. Forty-four percent had ischemic cardiomyopathy (ICM). In 33,8% (n=23) an epicardial lead was implanted for cardiac ressynchronization. Patients with transvenous leads were more frequently male (59,6% vs 40,4%). There were no significant differences in age, QRS duration and LVEF pre-implantation. At baseline, median LVEF in patients with EPL was 28±6% and 25±8% in patients with transvenous leads (p=0,356). Six months after resynchronization median LVEF was also not different between groups (37±13% in patients with transvenous leads and 42±20% in patient with EPL; p=0,248). However, patients with ischemic cardiomyopathy showed a statistically significant higher LVEF with EPL compared with patients with non-ischemic cardiomyopathy (p=0,01)</p> <p>Conclusions: In our sample, patients with ischemic cardiomyopathy showed a higher increase in LVEF with cardiac ressynchronization with epicardial leads. This effect may be due to a best myocardial location for pacing by avoiding fibrotic areas.</p>
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