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Clinical efficiency and durability of the epicardial left ventricular leads in cardiac resynchronization therapy.
Session:
Sessão de Posters 30 - Terapia de Ressincronização Cardíaca
Speaker:
Tatiana Pavlenko
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
09. Device Therapy
Subtheme:
09.6 Device Therapy - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Tatiana Pavlenko; Ana Lousinha; Ana Raquel Santos; André Ferreira; Rita Contins; Manuel Brás; Pedro Félix; Rui Rodrigues; Pedro Coelho; Hagen Kahlbau; Mario Oliveira
Abstract
<p>Background: Cardiac resynchronization therapy (CRT) remains an important component of heart failure (HF) treatment for patients (P) with reduced left ventricular ejection fraction (EF≤35%) and wide QRS. Unfavourable coronary sinus (CS) anatomy or previous cardiac implantable device (CIED) infection may lead to the necessity of implantation of an epicardial left ventricular lead (ELV). However, the data according to the endurance and efficiency of these leads is still scarce.</p> <p>Aim: To estimate the clinical efficiency and durability of the ELV in patients who required CRT.</p> <p>Methods: Consecutive cases of ELV implantation in P with indication for CRT at our centre from 2013 to 2023 were reviewed. Statistical analysis was performed with the Wilcoxon signed-rank test.</p> <p>Results: From a total of 16 cases (75% male, age 69,8±2 years, 37,5% with atrial fibrillation, 31,3% with coronary artery disease, 12,5% diabetes and 6,3% chronic kidney disease under dialysis), 12P required ELV due to unfavourable CS anatomy, 2P had high threshold and loss of capture of the transvenous CS lead and 2P had previous CIED infection. Indications for CRT were HF with reduced EF and wide QRS (n=14) and pacing-induced cardiomyopathy after pacemaker (PM) implantation (n=2). The mean NYHA class before ELV implantation was 3,1±0,2, QRS duration 171±5,6ms and the mean EF 28,2±1,7%. Ten P implanted a CRT-D, 5P a CRT-P and 1P a PM with ELV. In one case, a high ELV threshold was registered after the procedure, which led to reimplantation in one week. No other complications were registered. All P completed 6-month follow-up (F/u). From those who were implanted before 2021 (n=13), the survival rate was 100% and 84,6% during 1- and 2-year F/u, respectively. Non-cardiac reason of death was reported in these P. During F/u, clinical response (decrease in ≥I NYHA class) was achieved in 81,3% of the P, the mean NYHA class was 1,9±0,2 (p<0.05, compared to baseline) and the mean QRS duration was 143,6±8,0ms (p<0.05, compared to baseline). Echocardiographic response (increase in EF≥10%) was achieved in 56,3%. The mean EF at 6- and 24-month F/u was 37±3,5% (n=12, p<0.05) and 38,4±3,4% (n=9, p<0.05), respectively. There was no lead failure or clinically significant rise of threshold during the whole period of observation.</p> <p>Conclusions: Implantation of ELV is a safe and effective option for CRT in P with unfavourable CS anatomy or previous CIED infection, showing stable threshold profile during a 2-year follow-up.</p>
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