Kivonat:
AimFailure rate to implant left ventricular (LV) lead
transvenously is 4-8% in cardiac resynchronization therapy (CRT)
patients. Epicardial lead placement is an alternative method and
if not applicable case reports and small series showed the
feasibility of endocardial LV lead implantation.
Electroanatomical mapping might be a useful tool to guide this
procedure.Methods and resultsFour patients had undergone
endocardial LV lead implantation after unsuccessful transvenous
implantation or epicardial LV lead dysfunction using the
transseptal approach. Electroanatomical mapping was used to mark
the location of the transseptal puncture. This location point
guided the mapping catheter from the subclavian access and
facilitated positioning of the LV lead at the adjacent latest
activation area of the left ventricle detected by activation
mapping. Endocardial active fixation LV leads were successfully
implanted in all patients with stable electrical parameters
immediately after implantation and over a mean follow-up of 18.3
months (lead impedance 520 +/- 177 vs. 439 +/- 119 Omega and
pacing threshold 0.8 +/- 0.2 V, 0.5 ms vs. 0.6 +/- 0.1 V, 0.5
ms, respectively). Patients were maintained on anticoagulation
therapy with a target international normalized ratio of 3.5-4.5
and did not show any thromboembolic, haemorrhagic events, or
infection. Echocardiography showed significant improvement of LV
systolic function with marked improvement of the functional
status.ConclusionsElectroanatomical mapping is a useful
technical tool to guide endocardial LV lead implantation. It
helps to identify the location of the transseptal puncture and
the use of activation mapping might facilitate location of the
optimal lead positions during CRT.