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Exploring a New Systematic Route for Left Ventricular Pacing in Cardiac Resynchronization Therapy

Abstract : Background:Frequency and distribution of left ventricular (LV) venous collaterals were studied in vivo to evaluate the ease and feasibility of implanting a new ultra-thin LV quadripolar microlead for cardiac resynchronization therapy (CRT).Methods and Results:Evaluable venograms were analyzed to define the prevalence of venous collaterals (>0.5 mm diameter) between: (1) different LV segments; and (2) different major LV veins in: unselected patients who underwent CRT from 2008 to 2012 at Rouen Hospital, France (retrospective); and CRT patients from the Axone Acute pilot study in 2018 (prospective). In prospective patients with evaluable venograms, LV microlead implantation was attempted. Thirty-six (21/65 retrospective, 15/20 prospective) patients had evaluable venograms with ≥1 visible venous collaterals. Collaterals were found between LV veins in all CRT patients with evaluable venograms. Regionally, prevalence was highest between: the apical inferior and apical lateral (42%); and mid inferior and mid inferolateral (42%) segments. Collateral connections were most prevalent between: the inferior interventricular vein (IIV) and lateral vein (64% [23/36]); and IIV and infero-lateral vein (36% [13/36]). Cross-vein microlead implantation was possible in 18 patients (90%), and single-vein implantation was conducted in the other 2 patients (10%).Conclusions:Venous collaterals were found in vivo between LV veins in all CRT patients with evaluable venograms, making this network an option for accessing multiple LV sites using a single LV microlead.
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Submitted on : Tuesday, May 25, 2021 - 4:32:08 PM
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Frédéric Anselme, Mohammad Albatat, Christelle Marquié, Christophe Leclercq, Philippe Ritter, et al.. Exploring a New Systematic Route for Left Ventricular Pacing in Cardiac Resynchronization Therapy. Circulation Journal, Japanese Circulation Society, 2021, 85 (3), pp.283-290. ⟨10.1253/circj.CJ-20-0266⟩. ⟨hal-03131448⟩

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