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. 2019 Aug 1;21(8):1237-1245.
doi: 10.1093/europace/euz116.

Long-term single-centre large volume experience with transseptal endocardial left ventricular lead implantation

László Gellér  1 , Zoltán Salló  1 , Levente Molnár  1 , Tamás Tahin  2 , Emin Evren Özcan  3 , Valentina Kutyifa  1   4 , István Osztheimer  1 , Szabolcs Szilágyi  1 , Nándor Szegedi  1 , Pál Ábrahám  1 , Astrid Apor  1 , Klaudia Vivien Nagy  1 , Annamária Kosztin  1 , Dávid Becker  1 , Szilvia Herczeg  1 , Endre Zima  1 , Béla Merkely  1
Affiliations

Long-term single-centre large volume experience with transseptal endocardial left ventricular lead implantation

László Gellér et al. Europace. .

Abstract

Aims: The aim of our study was to investigate the long-term efficacy and safety of transseptal endocardial left ventricular lead implantation (TELVLI).

Methods and results: Transseptal endocardial left ventricular lead implantation was performed in 54 patients (44 men, median age 69, New York Heart Association III-IV stage) between 2007 and 2017 in a single centre. In 36 cases, the transseptal puncture (TP) was performed via the femoral vein, and in 18 cases, the TP and also the left ventricular (LV) lead placement were performed via the subclavian vein. An electrophysiological deflectable catheter was used to reach the LV wall through the dilated TP hole. The LV lead implantation was successful in all patients. A total of 54 patients were followed up for a median of 29 months [interquartile range (IQR) 8-40 months], the maximum follow-up time was 94 months. Significant improvement in the LV ejection fraction was observed at the 3-month visit, from the median of 27% (IQR 25-34%) to 33% (IQR 32-44%), P < 0.05. Early lead dislocation was observed in three cases (5%), reposition was performed using the original puncture site in all. The patients were maintained on anticoagulation therapy with a target international normalized ratio between 2.5 and 3.5. Four thromboembolic events were noticed during follow-up. A total of 27 patients died, with a median survival of 15 months (IQR 6-40).

Conclusion: The TELVLI is an effective approach for cardiac resynchronization therapy (CRT) however it is associated with a substantial thromboembolic risk (7%).

Keywords: Cardiac resynchronization therapy; Endocardial; Heart failure; Lead; Transseptal.

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Figures

Figure 1
Figure 1
(A) Transseptal puncture; the transseptal sheath (Swartz SL0 sheath, St. Jude Medical, Saint Paul, MN, USA) is in the left atrium. The patient has previously undergone a TAVI (transcatheter aortic valve implantation) procedure, the frame of the prosthetic valve can be seen. (B) Dilation of the interatrial hole with the peripheral balloon (the distal part of the guidewire is in the left superior pulmonary vein). CS, coronary sinus decapolar catheter; ICE, intracardiac echocardiography catheter; RA, right atrial lead; RV shock, right ventricular shock lead; old RV pacemaker, previously implanted right ventricular pacemaker lead.
Figure 2
Figure 2
(A) The TP hole was found with the help of a deflectable electrophysiological catheter (Abl). (B) The electrophysiological catheter (Abl) was guided through the interatrial septum into the left atrium. CS, coronary sinus decapolar catheter; ICE, intracardiac echocardiography catheter; RA, right atrial lead; RV shock, right ventricular shock lead; old RV pacemaker, previously implanted right ventricular pacemaker lead; TP, transseptal puncture.
Figure 3
Figure 3
(A) The coronary sinus sheath was inserted to the left ventricle through an electrophysiological catheter (CS cath). (B) The left ventricular active fixation lead (LV lead) in the CS sheath which is in the cavity of the left ventricle. CS, coronary sinus decapolar catheter; ICE, intracardiac echocardiography catheter; RA, right atrial lead; RV shock, right ventricular shock lead; old RV pacemaker, previously implanted right ventricular pacemaker lead.
Figure 4
Figure 4
The final picture, an anteroposterior (AP) and a left anterior oblique (LAO) view. The left ventricular lead (LV lead) is in the left lateral region of the left ventricle. The old RV pacemaker lead was explanted successfully by simple traction. RA, right atrial lead; RV shock, right ventricular shock lead.
Figure 5
Figure 5
CARTO image, left lateral projection. Right and the LV activation map: the earliest activation site is the right ventricular anteroseptal region; the latest site is the mid-basal part of the posterolateral wall. LV, left ventricular.
Figure 6
Figure 6
Survival after the transseptal left ventricular lead implantation.
See this image and copyright information in PMC

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