Hof, M. (2012) Performance of epicardial leads versus transvenous leads in cardiac resynchronization therapy. thesis, Medicine.
Full text available on request.Abstract
Aim: To evaluate short- and long-term performance of left ventricular epicardial leads compared to transvenous lead placement in cardiac resynchronization therapy (CRT). Background: CRT has proven to be an effective treatment option for heart failure patients with electromechanical dyssynchrony. However 30-40% does not respond to this therapy and therapy can initially fail most often due to inaccessible coronary sinus (CS) anatomy. Patients and methods: This study included all patients receiving left ventricular epicardial leads for CRT from 2007 to 2011 in our center. A control group was composed of patients who received a transvenous lead implantation from 2005 to 2009. After failed CS approach, patients were referred for an epicardial lead placement by a thoracic surgeon. Left ventricular end systolic volumes were measured at baseline and after 6 months. A reduction of >15% was defined as indicator for response to CRT. Furthermore energy consumption of the leads is measured by obtaining threshold values, impedance levels and pulse width in milliseconds. Results: Of all patients undergoing CRT since 2007, 91% had successful implantation and 9% were referred for epicardial lead placement. In total 312 patients were included with a mean age of 66±11 years, New York Heart Association functional class II-IV, QRS duration of 164±30ms and left ventricular ejection fraction of 24±8%. Baseline characteristics were comparable between both groups. An epicardial lead was placed in 37 patients and 275 patients received a transvenous lead. Follow-up time was 14±12 months and 23±13 months for epicardial vs. transvenous group, respectively. There was no lead failure observed in the epicardial group and there were 19 of 275 (7%) lead failures observed in the transvenous group. Causes of left ventricular (LV) lead complications were dislocation (n=11), intractable phrenic nerve stimulation (n=3), lead fracture (n=4) or exit block (n=1). Response to CRT was observed in 14 of 23 (61%) patients with an epicardial lead and in 123 of 204 (60%) patients with a transvenous lead (p=0.98). Conclusion: CS lead placement is successful in 91% of patients and may give subsequently a higher rate of lead failure than epicardial leads. Reverse left ventricular remodeling by CRT is comparable between CS and epicardially delivered LV leads. Note: Publication The results of this thesis will be used for future publication
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Maass, A.H. MD and Department of Cardiology and thoracic surgery, Thoraxcenter and University Medical Center Groningen |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:48 |
| Last Modified: | 25 Jun 2020 10:48 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/963 |
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