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A novel way to facilitate left ventricular lead implantation: Jailed catheter technique.

ABSTRACT: An important therapeutic modality for heart failure with left ventricular dyssynchrony, left ventricular lead placement, cannot be achieved due to anatomic challenges in some cases. In the current case, a novel implantation technique to overcome an anatomic difficulty, angled takeoff of the side branch of the coronary sinus, was presented.

SUBMITTER: Cay S

PROVIDER: S-EPMC5891404 | biostudies-literature | 2018 Apr

REPOSITORIES: biostudies-literature

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A novel way to facilitate left ventricular lead implantation: Jailed catheter technique.

Cay Serkan S Ozeke Ozcan O Ozcan Firat F Aras Dursun D Topaloglu Serkan S

Journal of arrhythmia 20180112 2

An important therapeutic modality for heart failure with left ventricular dyssynchrony, left ventricular lead placement, cannot be achieved due to anatomic challenges in some cases. In the current case, a novel implantation technique to overcome an anatomic difficulty, angled takeoff of the side branch of the coronary sinus, was presented. ...[more]

PMID: 29657595

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A case report of balloon-assisted tracking to overcome coronary sinus competent valve: a novel technique in left ventricular lead implantation.

Project description:BackgroundCompetent lateral and posterolateral valves showed proximal tortuosity that might hinder left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT).Case summaryA 57-year-old woman was diagnosed as non-ischaemic cardiomyopathy, no other comorbidities, complaining of dyspnoea [New York Heart Association (NYHA) class III], and on optimal medical therapy. Electrocardiogram showed left bundle branch block with QRS duration 150 ms. The patient was candidate for CRT. However, during LV lead implantation, a competent posterolateral vein valve and proximal tortuosity hindered LV lead implantation that was overcome by balloon-assisted tracking technique. At 9 months of follow-up, the patient had NYHA class II, ejection fraction improved to 38%, and all implanted leads were still in place.DiscussionBalloon-assisted tracking technique can be used to cross coronary sinus and smaller veins with competent valves and coronary veins tortuosity.

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Successful implantation of a left ventricular lead in an anomalous coronary sinus.

Project description:We describe the case of a 56-year-old man who was referred for CRT implantation and found to have anomalous CS. Catheterization of the CS initially failed due to this anomaly. However, a single large posterior-lateral branch with diminutive CS in the atrioventricular groove allowed for successful implantation of the LV lead.

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Stroke and pump thrombosis following left ventricular assist device implantation: The impact of the implantation technique.

Project description:ObjectivesSeveral studies have shown the potential advantage of less-invasive surgery (LIS) for left ventricular assist device (LVAD) implantation. This study aims to determine the impact of LIS on stroke and pump thrombosis events after LVAD implantation.MethodsBetween January 2015 and March 2021, 335 consecutive patients underwent LVAD implantation using either conventional sternotomy (CS) or the LIS technique. Patient characteristics was prospectively collected. All patients were followed up until October 2021. Logistic multivariate regression and propensity-matched analyses were performed to account for confounding factors.ResultsA total of 242 patients (F = 32; 13.0%) underwent LVAD implantation with CS and 93 patients (F = 8; 8.6%) with the LIS approach. Propensity matching generated two groups, including 98 patients in the CS group and 67 in the LIS group. Intensive care unit stay for the LIS group patients was significantly shorter than that for the CS group patients [2 (IQR: 2-5) days vs. 4 (IQR: 2-12) days, p < 0.01]. There were no significant differences in the incidence of stroke events (14% in CS vs. 16% in the LIS group; p = 0.6) or in pump thrombosis (6.1% in CS vs. 7.5% in the LIS group; p = 0.8) between the groups. The hospital mortality rate in the matched cohort was significantly lower in the LIS group (7.5% vs. 19%; p = 0.03). However, the 1-year mortality rate showed no significant difference between both groups (24.5% in CS and 17.9% in LIS; p = 0.35).ConclusionsThe LIS approach for LVAD implantation is a safe procedure with potential advantage in the early postoperative period. However, the LIS approach remains comparable to the sternotomy approach in terms of postoperative stroke, pump thrombosis, and outcome.

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Case report: A novel surgical technique for rapid valve-in-ring implantation into the native aortic annulus during left ventricular assist device implantation.

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Project description: Not available

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Feasibility of intraprocedural integration of cardiac CT to guide left ventricular lead implantation for CRT upgrades.

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A left ventricular lead implantation at the latest site based on four-dimensional computed tomography: a case report.

Project description:BackgroundCardiac resynchronization therapy (CRT) could be an effective therapy for patients suffering from severe heart failure (HF) despite optimal medical therapy. However, it has been reported that about 30% of patients receive ineffective results even if CRT has been performed. In a recent study, four-dimensional computed tomography (4DCT) was shown to be useful for pre-operative planning in transcatheter aortic valve intervention. The 4DCT is reconstructed with 10% increments over the cardiac cycle so that the displacement of the myocardium can be evaluated over time. From the above, we considered that the most delayed site where we would implant the left ventricular (LV) lead could be recognized by 4DCT.Case summaryA 55-year-old man with a recurrent admission for HF indicated for CRT was referred to our hospital. In this patient, the 12-lead electrocardiogram (ECG) showed a relatively narrow QRS complex with a left bundle branch block pattern. An echocardiography demonstrated severe LV dysfunction. Although no dyssynchrony was detected, the LV lead was inserted into the most delayed site based on the 4DCT. Three-month later, the ejection fraction increased and the cardiothoracic ratio obviously shortened.DiscussionWe experienced a case in which we could evaluate the effective implantation site for the LV lead based on the 4DCT even though the effective site was not detected by echocardiography, and we could implant the LV lead at that effective site. The 4DCT may be useful for implanting LV leads in effective sites.

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Novel mapping algorithm during catheter ablation for ventricular parasystole originating from left anterior fascicle.

Project description:A 17-year-old woman presented with frequent palpitations and shortness of breath and was diagnosed with drug-refractory ventricular parasystole. We predicted that the parasystole originated from the left anterior fascicle (LAF). Detailed activation maps of both conduction systems, including the LAF, during sinus rhythm and ventricular parasystole were obtained using a parallel mapping system. We confirmed the earliest fascicular potential of the parasystole and performed catheter ablation with no complications. This novel mapping algorithm for simultaneous acquisition of multiple maps aided effective treatment of ventricular parasystole originating from the LAF.

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Predictors of right ventricular failure after left ventricular assist device implantation.

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