Initial experience with a new transvenous electrode for left ventricular stimulation

Background: Left ventricular and biventricular pacing has recently been int roduced as a new therapy for chronic heart failure in selected patients. We report our initial experience with a new electrode for transvenous left ep icardial pacing via tributaries of the coronary sinus. Patients and Method: Inclusion criteria were: chronic heart failure NYHA gr eater than or equal to II, ORS-duration > 120 ms, left ventricular ejection fraction < 35% Dual chamber pacemakers (CPI Contak TR(R)) or defibrillator s (CPI Contak CD(r)) designed for atrial triggered biventricular stimulatio n were implanted in conjunction with the CPI Easytrak((R))-lead for left ve ntricular pacing in a coronary vein. Lead placement was achieved via a subc lavian vein access and a preformed guiding catheter for coronary sinus inse rtion. Results: In 13 of 16 patients (87%) the left ventricular lead was implanted successfully in a mid to distal posterior or anterolateral vein. Lead inse rtion could not be achieved in 2 patients with significant cardiomegaly and right atrial enlargement (12.5%), while 1 patient with a history of myocar dial infarction and small anterior ventricular aneurysm had inacceptable hi gh left ventricular pacing thresholds intraoperatively. The implantation wa s well tolerated by all patients without complications. There was no case o f lead dysfunction (mean follow-up time: 142 +/- 126 days). Intraoperative electrode measurements and chronic pa ra meters (<greater than or equal to> 3 months, n = 8) a re given in Table 1. Conclusion: In the past left Ventricular pacing has mainly been achieved by epicardially placed electrodes after thoracotomy with conventional electro des. This new approach for chronic left ventricular pacing uses the familia r transvenous over-the-wire technique in combination with a newly developed guiding catheter and electrode for pacing in left epicardial veins. Lead p lacement was shown to be safe and success rate was higher than in previous reports with standard electrodes. We conclude that left epicardial lead pla cement with the over the-wire technique and a preformed guiding catheter fo r coronary sinus access presents as a safe and maybe more efficient method for left ventricular pacing.