Coronary venoplasty during cardiac resynchronization therapy device implantations: acute results and clinical outcomes.

Abstract

BACKGROUND\nOptimal left ventricular (LV) lead placement improves response to cardiac resynchronization therapy (CRT) but can be hindered by unfavorable venous anatomy. Interventional procedures in the coronary veins have been described with promising short-term outcomes.\n\n\nOBJECTIVE\nTo establish the safety and efficacy of percutaneous coronary venoplasty (PCV) during CRT implantation and assess medium term lead performances and clinical outcomes against matched controls not requiring PCV METHODS: Each consecutive PCV case was matched according to age, gender and bundle branch morphology to 2 controls from a large prospective registry of CRT recipients. Demographics, procedural success, lead performance and response to CRT were tracked using a comprehensive electronic medical records system.\n\n\nRESULTS\nOf 422 consecutive CRT recipients treated between 2012 to 2018, 29 (6.9%) patients (mean age 65.7 ± 10.7 years; 7 female, 17 ischemic cardiomyopathy, 22 left bundle branch block) required PCV, which was successful in 21 (72%) cases. Target veins measuring 1.1 ± 0.6 mm were dilated by non-compliant balloons with mean diameters of 2.8 ± 0.5mm. No complications occurred. Fluoroscopic and procedural duration were longer in the PCV group. (p < 0.01) Over a mean follow-up of 33.0 ± 25.0 months, no difference in lead performance, CRT response, 2-year survival were observed compared to the control group.\n\n\nCONCLUSIONS\nPercutaneous coronary venoplasty during CRT device implant is typically successful, safe and associated with long-term clinical outcomes comparable to patients who did not need PCV. This is an important technique to optimize LV lead placement and maximize CRT response.