Balloon angioplasty of cardiac vein in a patient treated by cardiac resynchronization therapy
Abstract
Introduction. Cardiac resynchronization therapy (CRT) reduces mortality and hospitalization in patients with symptomatic heart failure and left bundle branch block (LBBB) on optimal drug therapy. Among all, the reasons for “non-response” to CRT pacemaker could be the failure to achieve optimal left ventricular (LV) lead position due to severe curve or stenosis/occlusion of the target vein. Case report. We presented a 79-old-male patient, New York Heart Association (NYHA) class III, with atrial fibrillation, chronic coronary syndrome (CCS), and prior myocardial infarction. The patient underwent coronary artery bypass surgery and mechanical prosthetic aortic valve implantation. He was indicated for CRT. The patient′s venogram revealed ostial/proximal severe curve and stenosis of the posterolateral vein, the only vein of coronary sinus that led to anatomically optimal LV segment for stimulation. After the balloon angioplasty of the curved and stenotic portion of the target vein with compliant balloon 4.0 × 30 mm, a satisfactory and stable position of quadripolar LV lead was achieved. Conclusion. Compliant balloon angioplasty could be a safe and efficient way to override severe coronary vein stenosis in some CRT cases.
References
Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37(27): 2129‒
Mullens W, Grimm RA, Verga T, Dresing T, Starling RC, Wilkoff BL, et al. Insights from a Cardiac Resynchronization Optimization Clinic as Part of a Heart Failure Disease Management Program. J Am Coll Card 2009; 53(9): 765‒
Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC Guidelines for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: The Task Force for the Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC). Endorsed By: Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J 2015; 36(41): 2793‒
Bristow MR, Saxon LA, Boehmer J, Krueger S, Kass DA, De Marco T, et al. Comparison of Medical Therapy, Pacing, and Defibrillation in Heart Failure (COMPANION) Investigators. Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure. N Engl J Med 2004; 350(21): 2140‒
Cleland JG, Daubert JC, Erdmann E, Freemantle N, Gras D, Kappenberger L, et al. The effect of cardiac resynchronization on morbidity and mortality in heart failure. N Engl J Med 2005; 352(15): 1539–49.
Moss AJ, Hall WJ, Cannom DS, Klein H, Brown MW, Daubert JP, et al. Cardiac-resynchronization therapy for the prevention of heart-failure events. N Engl J Med 2009; 361(14): 1329–38.
Tang AS,Wells GA, Talajic M, Arnold MO, Sheldon R, Connolly S, et all. Resynchronization-Defibrillation for Ambulatory Heart Failure Trial (RAFT) Investigators. Cardiac-resynchronization therapy for mild-to-moderate heart failure. N Engl J Med 2010; 363(25): 2385–95.
Worley SJ. Implant Venoplasty: Dilation of Subclavian and Coronary Veins to Facilitate Device Implantation: Indications, Frequency, Methods, and Complications. J Cardiovascular Electrophysiol. 2008; 19(9): 1004–7.
Soga Y, Ando K, Yamada T, Goya M, Shirai S, Sakai K, et al. Efficacy of Coronary Venoplasty for Left Ventricular Lead Implantation. Circ J 2007; 71(9): 1442–5.
Luedorff G, Grove R, Kranig W, Thale J. Different venous angioplasty manoeuvres for successful implantation of CRT devices. Clin Res Cardiol 2009; 98(3): 159–64.
Abben RP, Chaisson G, Neir V.Traversing and dilating venous collaterals: a useful adjunct in left ventricular electrode placement. J Invasive Cardiol 2010. 22 (6): E93–6.
Jachec´ W, Wojciechowska C, Tomasik A, Gala A, Kubiak G, Kawecki D, et al. Case Report: Therapeutic percutaneous transluminal angioplasty with a stenting procedure of a stenosed great cardiac vein in a patient with dilated cardiomyopathy submitted to biventricular pacemaker implantation. Cor et Vasa. 2013; 55: E541–4.
Oto A, Aytemir K, Okutucu S, Canpolat U, Sahiner L, Ozkutlu H. Percutaneous coronary sinus interventions to facilitate implantation of left ventricular lead: a case series and review of literature. J Card Fail 2012; 18(4): 321–9.
Ypenburg C, van Bommel RJ, Delgado V, Mollema SA, Bleeker GB, Boersma E, et al. Optimal left ventricular lead position predicts reverse remodeling and survival after cardiac resynchronization therapy. J Am Coll Cardiol. 2008; 52(17): 1402–9.