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Transvenous lead vs epicardial lead: Impact of the different approach in cardiac resynchronization therapy
Session:
Painel 5- Arritmologia 4
Speaker:
Tamara Pereira
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.3 Cardiac Resynchronization Therapy
Session Type:
Posters
FP Number:
---
Authors:
Tamara Pereira; Bebiana Faria; Pedro Von Hafe Leite; Geraldo Dias; Ana Filipa Cardoso; Sérgio Leite; Lucy Calvo; Francisco Castro Ferreira; Vítor Sanfins; António Lourenço
Abstract
<p>Background: Transvenous coronary sinus lead is the most common approach for cardiac resynchronization therapy (CRT) left ventricular lead (LVL) implant. However, this approach is not possible in some patients and epicardial leads (EPL) can be a solution. Since data comparing performance of these two lead types are limited, we decided to assess the response to CRT according to the approach type.</p> <p> </p> <p>Methods: Retrospective, single-center study of 143 patients undergoing CRT implantation between 2013 and 2017 according to the current <em>guidelines</em> indications. Clinical, electrocardiographic and echocardiographic parameters were evaluated. Response to CRT was defined as an improvement in left ventricle ejection fraction (LVEF) >10%.</p> <p> </p> <p>Results: From the 143 patients (mean age 67.5 ± 10.8 years, 69.9% males, 42.4% ischemic, 31.5% atrial fibrillation) submitted to CRT implantation, 95 received transvenous coronary sinus and 48 epicardial left ventricular leads.</p> <p>Patients with EPL were more frequently male (82% vs 64%, p=0.032) and diabetics (63% vs 37%, p=0.006). At the basal evaluation, the median LVEF was 28% [24-30], end-diastolic volume was 175ml [137-216], end-systolic volume was 117 ml [99-167] and there were no statistic differences between the groups. There were no statistic differences in age, QRS duration and renal function.</p> <p>Regarding CRT efficacy, there was an increase in LVEF (10.5 % in transvenous vs 14.9% in epicardial, p=0.068), reduction of New York Heart Association (NYHA) class in 85.6% of the patients (87% transvenous vs 83.3% epicardial, p=0.755) in whom 9.1% of them improve from class III to I of NYHA, reduction of ventricular end-diastolic volume (25.1 ml in transvenous vs 21.1ml in epicardial, p=0.115) and reduction in degree of mitral valve insufficiency in 50.6% of patients (40% in transvenous vs 64.1% epicardial leads, p=0.034). </p> <p>There was a higher degree of responders in the EPL group (78% vs 50%, p=0.037).</p> <p>Conclusions: In this study, patients with an epicardial lead showed a significantly higher degree of responders to CRT, showing that it could represent a good alternative when transvenous implantation fails or is not possible. We need to collect more data in order to clarify the role of epicardial lead.</p>
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