Challenges and Solutions for Difficult Implantations of CRT Devices: The Role of New Technology and Techniques

doi:10.1111/j.1540-8167.2007.00707.x

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Wiley InterScience

Journal of Cardiovascular Electrophysiology

Volume 18 Issue s1, Pages S21 - S25

Published Online: 20 Dec 2006

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Challenges and Solutions for Difficult Implantations of CRT Devices: The Role of New Technology and Techniques

RICHARD K. SHEPARD, M.D.* and KENNETH A. ELLENBOGEN, M.D.*

From the *Division of Cardiology Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia, USA

Address for correspondence: Richard K. Shepard, M.D., Cardiac Electrophysiology, Virginia Commonwealth University, P.O. Box 980053, Richmond, VA 23298. Fax: 804-828-6082; E-mail: rshepard@vcu.edu

KEYWORDS

biventricular pacing • cardiac resynchronization therapy • congestive heart failure

Difficult CRT Device Implantation Procedures.

(J Cardiovasc Electrophysiol, Vol. 18, pp. S21-S25, Suppl. 1, January 2007)

ABSTRACT

Introduction: Cardiac resynchronization therapy (CRT) can markedly improve heart failure treatment in selected patients, but left ventricular (LV) lead implantation can be difficult or optimal lead position not obtainable.

Methods: This review examines newer techniques and technologies to optimize implant success. Goals of implant include placement of the LV lead in a coronary vein near the midlateral left ventricle with good lead stability, adequate thresholds, and no phrenic nerve stimulation. We will examine methods to access difficult and tortuous veins, test multiple veins for the best pacing site, and avoid complications. Newer technologies that will be discussed include magnetic wire navigation using Stereotaxis™, endoscopic, and CT-guided approaches, and nontraditional methods such as pericardial puncture for epicardial LV lead placement.

Conclusion: The methods discussed here may help to make CRT implant safer, faster, and more successful.

DIGITAL OBJECT IDENTIFIER (DOI)

10.1111/j.1540-8167.2007.00707.x About DOI