Adverse events with transvenous left ventricular pacing in patients with severe heart failure: early experience from a single centre

Aims Assessment of complications following implantation of transvenous vent ricular electrodes to pace the left ventricle. Methods and Results Twenty-eight patients with severe cardiac failure and l eft bundle branch block were prospectively followed for adverse effects of implantation of a left ventricular transvenous pacing system. Immediate fol lowup was associated with loss of left ventricular pacing in nine patients (32%). This was due to lead dislodgement in four cases (corrected by re-ope ration in three of these cases), and due to increased threshold in five cas es (corrected by programming a higher pacing amplitude in all five cases, b ut with intermittent diaphragmatic contraction in one case). After 1 month, one patient died, one patient with severe coronary heart disease suffered a myocardial infarction, and left ventricular pacing was lost in two patien ts. Pericardial effusion, new significant ventricular arrhythmias or other adverse effects were not observed. After a mean follow-up of 16 +/- 9.2 mon ths, pacing leads remained stable and no late complications related to the transvenous left ventricular epicardial pacing were observed. Conclusion Placement of a permanent lead in a tributary of the coronary sin us is feasible without serious adverse effects during the first month. The only frequent adverse event was lead dislodgement; a finding which emphasiz es the need for development of specially designed leads for this applicatio n. (Europace 2001; 3: 60-63) (C) 2001 The European Society of Cardiology.