Archives of Biological Sciences 2011 Volume 63, Issue 3, Pages: 635-640
https://doi.org/10.2298/ABS1103635P
Full text ( 461 KB)
Is cardiac venous anatomy a crucial factor in maximizing the response to cardiac resynchronisation therapy?
Putnik S. (Clinic for Cardiac Surgery, Clinical Centre of Serbia, Belgrade)
Savić D. (Pacemaker Centre, Clinical Centre of Serbia, Belgrade)
Matković M. (Medical Faculty, Belgrade)
Gluvić Z. (Clinical-Hospital Centre Zemun, Belgrade)
Lačković Milena (Clinical-Hospital Centre Zemun, Belgrade)
Ilić G. (Clinical-Hospital Centre Zemun, Belgrade)
Milašinović G. (Pacemaker Centre, Clinical Centre of Serbia, Belgrade)
Cardiac resynchronization therapy (CRT) restores the synchrony of the heart’s
contractions. The most critical issue in CRT implantation is the positioning
of the coronary sinus (CS) lead because not every region can be accessed due
to variations in coronary venous anatomy. The aim was to determine the
correlation between different CS lead positions and hemodynamic changes and
clinical outcome over time. Our study prospectively enrolled 51 patients with
conventional indications for CRT which was divided into three groups
according to the vein in which the left ventricle lead was placed during the
procedure (posterior, lateral, and anterior). The groups were compared by
baseline demographic characteristics, comorbidity, complications, new
hospitalizations as well as by hemodynamic parameters before and six months
after the procedure. After six months, all patients responded to CRT in the
lateral group, 66.7% patients in the posterior group and 50% in the anterior
group (p<0.01). Patients in the anterior group had a smaller decrease in NYHA
functional class compared to the posterior and the lateral groups (p<0.01).
The largest increase of preoperative ejection fraction value was in the
posterior group (68.7%) compared to the lateral (42.2%) and anterior groups
(19.8%) (p<0.01, A vs. P&L; P vs. A&L). In the anterior group there was a
smaller decrease of QRS complex compared to the posterior and lateral groups
(p< 0.05, A vs. P&L). Also there was a smaller decrease in the degree of
mitral regurgitation in the anterior group compared to the lateral and
posterior groups (p<0.05, A vs. P&L). One of the main determinants of CRT
response is the anatomy of CS tributaries, and therefore the position of the
LV lead is crucial in maximizing the effect of CRT.
Keywords: Cardiac resynchronization therapy, coronary sinus venography, lead position