Cardiac venous injuries: Procedural profiles and outcomes during left ventricular lead placement for cardiac resynchronization therapy.
Aged
Cardiac Resynchronization Therapy Devices
/ adverse effects
Coronary Angiography
Coronary Vessels
/ injuries
Electrocardiography
Electrodes, Implanted
/ adverse effects
Female
Follow-Up Studies
Heart Failure
/ physiopathology
Heart Injuries
/ diagnosis
Humans
Male
Prognosis
Retrospective Studies
Cardiac resynchronization therapy
Coronary sinus dissection
Coronary sinus perforation
Coronary venous injury
Morbidity
Mortality
Outcomes
Journal
Heart rhythm
ISSN: 1556-3871
Titre abrégé: Heart Rhythm
Pays: United States
ID NLM: 101200317
Informations de publication
Date de publication:
08 2020
08 2020
Historique:
received:
30
01
2020
accepted:
11
03
2020
pubmed:
25
3
2020
medline:
1
9
2021
entrez:
25
3
2020
Statut:
ppublish
Résumé
Injury to the cardiac venous structures can complicate left ventricular lead placement for cardiac resynchronization therapy (CRT). Little is known about the outcomes of coronary sinus (CS) dissection with or without perforation. The purpose of this study was to determine the outcomes in patients who had a CS injury during CRT implantation. All patients undergoing procedures for CRT implantation at the Cleveland Clinic (2001-2018) were enrolled in a prospectively maintained registry for procedural profiles and complications. All patients with cardiac venous injuries during the procedures were included. CS injury occurred in 35 of 5011 patients (0.7%; 6 perforations (17.1%), 29 dissections without perforation (82.9%)). In patients with dissection in the absence of perforation, attempts at CS lead placement after dissection were successful in 21 of 29 patients (72.4%). In those with perforation (n=6, 17.1%), CS lead placement was successful in one of them (16.7%). Cardiac tamponade occurred in 2 patients (5.7%), and the procedure was aborted in both of them. Overall, CS lead placement failed in 13 patients (37%) but 9 (25.7%) underwent subsequent CRT with CS lead placement (n=6, 17.1%; median 58 days later) or epicardial leads (n=3, 8.6%). Three of the remaining 4 patients (8.6%) refused to undergo further procedures, and the fourth (2.9%) died of a complicated course. CS injury is not common during CRT implantation procedures and did not preclude successful lead placement in 23 of 35 patients (65.7%) during the index procedure and 6 of 6 (100%) during the subsequent attempted procedures. A low rate of mortality was observed in such patients, but CS injury was associated with increased morbidity.
Sections du résumé
BACKGROUND
Injury to the cardiac venous structures can complicate left ventricular lead placement for cardiac resynchronization therapy (CRT). Little is known about the outcomes of coronary sinus (CS) dissection with or without perforation.
OBJECTIVE
The purpose of this study was to determine the outcomes in patients who had a CS injury during CRT implantation.
METHODS
All patients undergoing procedures for CRT implantation at the Cleveland Clinic (2001-2018) were enrolled in a prospectively maintained registry for procedural profiles and complications. All patients with cardiac venous injuries during the procedures were included.
RESULTS
CS injury occurred in 35 of 5011 patients (0.7%; 6 perforations (17.1%), 29 dissections without perforation (82.9%)). In patients with dissection in the absence of perforation, attempts at CS lead placement after dissection were successful in 21 of 29 patients (72.4%). In those with perforation (n=6, 17.1%), CS lead placement was successful in one of them (16.7%). Cardiac tamponade occurred in 2 patients (5.7%), and the procedure was aborted in both of them. Overall, CS lead placement failed in 13 patients (37%) but 9 (25.7%) underwent subsequent CRT with CS lead placement (n=6, 17.1%; median 58 days later) or epicardial leads (n=3, 8.6%). Three of the remaining 4 patients (8.6%) refused to undergo further procedures, and the fourth (2.9%) died of a complicated course.
CONCLUSION
CS injury is not common during CRT implantation procedures and did not preclude successful lead placement in 23 of 35 patients (65.7%) during the index procedure and 6 of 6 (100%) during the subsequent attempted procedures. A low rate of mortality was observed in such patients, but CS injury was associated with increased morbidity.
Identifiants
pubmed: 32205298
pii: S1547-5271(20)30207-1
doi: 10.1016/j.hrthm.2020.03.011
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1298-1303Informations de copyright
Copyright © 2020. Published by Elsevier Inc.