Basous, S. (2014) Cardiac Resynchronization Therapy in treatment of heart failure: Performance of transvenous leads versus epicardial leads. thesis, Medicine.
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Abstract
Introduction: Over the past decades Cardiac Resynchronization Therapy has taken a central place in the treatment of heart failure patients with electromechanical dyssynchrony. An important aspect of therapy is the performance of left ventricular lead. Performance depends on anatomy of the coronary sinus, lead dislocations, stimulation of phrenic nerve and lead thresholds. Lead failure up to 10% of cases has been mentioned in transvenous lead placement and there is no long term data available of epicardial leads. Aim: To determine the incidence of left ventricular lead failure after transvenous and epicardial lead placement. Methods: This study included 508 patients who received Cardiac Resynchronization Therapy in our center from January 2001 until January 2013. After unsuccessful transvenously left ventricular lead placement, patients received epicardially placed left ventricular lead. The study group included 466 transvenous leads and 42 epicardial leads. Follow up moments were; at day one after implantation, 2 months, 6 months and then at every 6 months. After 36th months measurement point, follow up was every 12 months. Complications were recorded for a maximum follow up time of 5 years. Results: Forty-three (9,2%) of 466 patients in the transvenously placed left ventricular lead group showed lead failure after a mean follow up of 3,54 ±1,41 years. Failure addressed to dislocation of leads was registered in 27(62,8%) of cases, phrenic nerve stimulations in 7(13,3%) cases, lead fractures in 5(11,6%) cases and infections in 4(9,3%) cases. No failure was registered in the epicardial placed left ventricular lead group after a mean follow up of 3,58 ±1,17 years. Difference was significant with p=0,048. The majority of patients in both groups were male and mean age at implantation for both groups was 65,6 years. Within the transvenous leads, we recorded a significant difference of p = 0,010 by polarity (unipolar vs. bipolar leads). Conclusion: Transvenously placed leads in Cardiac Resynchronization Therapy has a higher failure in comparison with epicardial placed leads. Surgical placed epicardial leads revealed excellent long-term results and a lower complications rate compared to transvenous leads. Therefore, epicardial lead placement might be a better option than transvenous placement for heart failure patients with Cardiac Resynchronization Therapy.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Maass, A.H. MD |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:05 |
| Last Modified: | 25 Jun 2020 11:05 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2496 |
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