Characterization of the suitability of coronary venous anatomy for targeting left ventricular lead placement in patients undergoing cardiac resynchronization therapy

Abstract

Aims: Recent studies suggest differences in coronary venous anatomy between patients with ischaemic (I) and non-ischaemic (N) cardiomyopathy. We hypothesize that these differences may affect the potential for left ventricular (LV) lead targeting in patients undergoing cardiac resynchronization therapy.

Methods and results: The retrograde contrast venograms were retrospectively reviewed in 133 patients (age 68 +/- 9 years, 101 males). The quantity and distribution of veins were recorded as well as the final lead position. There were no major differences in the distribution of LV lead positions between I and N [posterior vein, 14.0% (I) vs. 15.8% (N); posterolateral vein, 21.1 vs. 18.4%; lateral vein, 59.7 vs. 50.0%; anterolateral vein, 3.5 vs. 13.2%; P= NS]. Excluding the middle and great cardiac veins, in total only 59 of 133 patients had more than one suitable vein as potential targets for LV lead placement (I, 36.8% vs. N, 50.0%; P = 0.16).

Conclusion: Underlying aetiology does not affect the quantity and distribution of coronary veins available for LV lead placement. The limitations of venous anatomy restrict LV lead placement to a single vein with little scope for site selection in almost half of all the patients. Given these limitations, in many patients, prospective targeting of LV lead placement may require a direct surgical approach.