Is interventional technique better than the traditional over-the-wire method for left ventricular lead implantation in cardiac resynchronization therapy?

Frederikke Nørregaard Jakobsen; Niels Christian Foldager Sandgaard; Thomas Olsen; Axel Brandes; Mogens Stig Djurhuus; Mie Schæffer; Anna Mejldal; Ole Dan Jørgensen; Jens Brock Johansen

doi:10.1016/j.hroo.2024.04.001

Is interventional technique better than the traditional over-the-wire method for left ventricular lead implantation in cardiac resynchronization therapy?

Heart Rhythm O2. 2024 Apr 5;5(5):281-288. doi: 10.1016/j.hroo.2024.04.001. eCollection 2024 May.

Affiliations

¹ Department of Cardiology, Odense University Hospital, Odense, Denmark.
² Open Patient Data Explorative Network, Odense University Hospital, Odense, Denmark.
³ Department of Cardiac, Thoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.
⁴ The Danish Pacemaker and ICD Register, Odense, Denmark.

Abstract

Background: Interventional cardiac resynchronization therapy (I-CRT) for left ventricular lead (LVL) placement works as a supplement to traditional (over-the-wire) cardiac resynchronization therapy (T-CRT). It has been argued that I-CRT is a time-consuming and complicated procedure.

Objective: The purpose of this study was to investigate differences in procedure-related, perioperative, postoperative, and clinical endpoints between I-CRT and T-CRT.

Methods: This single-center, retrospective, cohort study included all consecutive patients receiving a CRT-pacemaker/defibrillator between January 1, 2012, and August 31, 2018. Patients underwent T-CRT from January 1, 2012, to June 1, 2015, and I-CRT from January 1, 2016, to August 31, 2018. We obtained data from patient record files, fluoroscopic images, and the Danish Pacemaker and ICD Register. Data were analyzed using Wilcoxon rank-sum/linear regression for continuous variables and the Pearson χ²/Fisher exact for categorical variables.

Results: Optimal LVL placement was achieved in 82.7% of the I-CRT group and 76.8% of the T-CRT group (P = .015). In the I-CRT group, 99.0% of LVLs were quadripolar vs 55.3% in the T-CRT group (P <.001). Two or more leads were used during the procedure in 0.7% and 10.5% of all cases in the I-CRT and T-CRT groups, respectively (P <.001). Total implantation time was 81.0 minutes in the I-CRT group and 83.0 minutes in the T-CRT group (P = .41). Time with catheters in the coronary sinus was 45.0 minutes for the I-CRT group vs 37.0 minutes in the T-CRT group, respectively (P <.001).

Conclusion: I-CRT did not prolong total implantation time despite longer time with catheters in the coronary sinus. I-CRT allowed more optimal LVL placement, wider use of quadripolar leads, and use of fewer leads during the procedure.

Keywords: Cardiac resynchronization therapy; Interventional cardiac resynchronization therapy; Left ventricular pacemaker lead placement; Optimal left ventricular lead placement; Traditional cardiac resynchronization therapy.