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Title: Bifocal right ventricular cardiac resynchronization therapies in patients with unsuccessful percutaneous lateral left ventricular venous access.
Austin Authors: O'Donnell, D ;Nadurata, V;Hamer, A;Kertes, P;Mohamed, U;Mohammed, W
Affiliation: Electrophysiology Unit, Austin Health, Studley Road, Heidelberg, Victoria, Australia
Issue Date: 1-Jan-2005
Publication information: Pacing and Clinical Electrophysiology : Pace; 28 Suppl 1(): S27-30
Abstract: Biventricular cardiac resynchronization therapy (CRT) with a lateral left ventricular (LV) lead cannot always be achieved. We report a single center experience of CRT utilizing a protocol that specifically required the implantation of a bifocal right ventricular (RV) lead system when lateral LV pacing could not be achieved. Consecutive candidates for CRT were included in the study. If strict criteria for lateral LV pacing were not met, they underwent implantation of a bifocal RV lead system with two 7F, active fixation leads, one placed septally at the apex, and the other in the high septal outflow tract. All patients were followed for 12 months and the two groups were compared. A biventricular (BiV) stimulation system was implanted in 44 patients, and a bifocal RV system in six. The demographic characteristics of the two groups were similar. Both groups experienced a similar improvement in functional capacity, increase in 6 minutes walking distance, and decreased need for hospitalizations. The mean increase in LV ejection fraction was 11% in the bifocal RV group versus 10% in the BiV group. Though the tissue Doppler indices of LV synchrony improved earlier in the BiV group, (19% vs 10%) the improvement was similar in both groups at 6 months (23% vs 20%). The clinical improvements conferred by CRT can be matched by a bifocal RV system in selected patients. This alternate approach should be considered when implantation of a LV lateral lead was unsuccessful.
Gov't Doc #: 15683513
DOI: 10.1111/j.1540-8159.2005.00069.x
Type: Journal Article
Subjects: Aged
Cardiac Pacing, Artificial.methods
Cardiac Surgical Procedures.methods
Coronary Vessels
Heart Failure.therapy
Middle Aged
Treatment Failure
Appears in Collections:Journal articles

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