Zusammenfassung
Die kardiale Resynchronisationstherapie mittels Koronarsinus-Elektroden ist inzwischen eine etablierte Methode zur Behandlung der Herzinsuffizienz, wenn gleichzeitig eine kardiale Asynchronie vorliegt. Eine erfolgreiche Behandlung ist von der Platzierung linksventrikulärer Elektroden in der Regel via CS abhängig. Dieser Eingriff ist schwieriger als die Implantation konventioneller Schrittmachersysteme und bedarf sorgfältiger Vorüberlegungen. Ohne entsprechende Vorbereitung und Übung kann sich ein solcher Eingriff leicht zu einer zeitraubenden Katastrophe auswachsen. Es wird deshalb die CS-Implantationstechnik mit dem Fokus auf mögliche Komplikationen ausführlich beschrieben, basierend auf eigenen Erfahrungen von 500 Implantationen der Jahre 1999–2007 und einer Literaturrecherche.
Abstract
Cardiac resynchronization therapy (CRT) using coronary sinus (CS) leads is an established method for the therapy of congestive heart failure (CHF) in the case of asynchronous ventricular contractions. Successful therapy depends on the placement of left ventricular leads usually via the coronary sinus (CS), a technically more challenging procedure than regular pacemaker implantations. Without specific precautions CRT implantation can be the gateway to a time consuming nightmare. Therefore CS lead implantation methods, with a focus on complications, were reviewed according to the literature and own experience with approximately 500 procedures from 1999–2007.
This is a preview of subscription content, log in via an institution to check access.
References
Azizi M, Castel MA, Behrens S, Rödiger W, Nägele H (2006) Experience with coronary sinus lead implantations for cardiac resynchronization therapy in 244 patients. Herzschr Elektrophys 17:13–18
Bristow MR et al; for the Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators (2004) Cardiacresynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 350:2140–2150
Cesario DA, Shenoda M, Brar R, Shivkumar K (2006) Left ventricular lead stabilization utilizing a coronary stent. Pacing Clin Electrophysiol 29:427–428
Danish Pacemaker Register Report (2003) Of the Danish Pacemaker Register
De Cock CC, Jessurun ER, Allaart CA, Visser CA (2004) Repetitive intraoperative dislocation during transvenous lead implantation: usefulness of the retained guidewire technique. Pacing Clin Electrophysiol 27:1589–1593
Ellenbogen KA, Hellkamp AS, Wilkoff BL, Camunas JL, Love JC, Hadjis TA, Lee KL, Lamas GA (2003) Complications arising after implantation of DDD pacemakers: the MOST experience. Am J Cardiol 92(6):740–741
Eucomed.org
Hansky B, Vogt J, Gueldner H, Schulte-Eistrup S, Lamp B, Heintze J, Horstkotte D, Koerfer R (2007) Implantation of active fixation leads in coronary veins for left ventricular stimulation: report of five cases. Pacing Clin Electrophysiol 30:44–49
Heist EK, Singh JP, Mela T, Ruskin JN (2007) Coronary venospasm causing chest pain during implantation of cardiac resynchronization therapy. Heart Rhythm 4:1108–1109
Kowalski O, Prokopczuk J, Lenarczyk R, Pruszkowska-Skrzep P, Polonski L, Kalarus Z (2006) Coronary sinus stenting for the stabilization of left ventricular lead during resynchronization therapy. Europace 8:367–370
Medina-Ravell VA, Lankipalli RS, Yan GX, Antzelevitch C, Medina-Malpica NA, Medina-Malpica OA, Droogan C, Kowey PR (2003) Effect of epicardial or biventricular pacing to prolong QT interval and increase transmural dispersion of repolarization does resynchronization therapy pose a risk for patients predisposed to long QT or Torsade de Pointes? Circulation 107:740–746
Nägele H, Hashagen S, Ergin M, Azizi M, Behrens S (2007) Coronary sinus lead fragmentation 2 years after implantation with a retained guidewire. PACE 30:438–439
Nägele H, Azizi M, Hashagen S, Castel MA, Behrens S (2007) First experience with a new active fixation coronary sinus lead. Europace 9:437–441
Punnam SR, Holiday J, Janes R, Touma R, Li H, Patel M, Abela GS, Thakur RK (2007) Hemodynamic collapse during left ventricular lead implantation. Pacing Clin Electrophysiol 30(9):1112–1115
The Task Force for Cardiac Pacing and Cardiac Resynchronization Therapy of the European Society of Cardiology (2007) Developed in Collaboration with the European Heart Rhythm Association Guidelines for cardiac pacing and cardiac resynchronization therapy. European Heart Journal 28:2256–2295
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nägele, H., Behrens, S. & Azizi, M. What can happen during coronary sinus lead implantation: dislocation, perforation and other catastrophes. Herzschr. Elektrophys. 18, 243–249 (2007). https://doi.org/10.1007/s00399-007-0587-4
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s00399-007-0587-4