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Similar benefits, more complications likely with surgically- vs. percutaneously placed LV leads
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Patients who underwent failed percutaneous left ventricular lead placement in the coronary sinus derived similar functional benefits following surgical lead placement, but also had increased risks for perioperative complications, study results indicated.
Researchers enrolled 452 patients who had undergone attempted coronary sinus lead insertion. All patients met accepted cardiac resynchronization therapy guidelines, including depressed ejection fraction (<35%), wide QRS complex (>120 ms) and advanced HF (NYHA Class III or IV). Forty-five patients who underwent surgical LV placement after failed percutaneous lead placement were matched with 135 patients who had successfully-placed percutaneous leads. Mean follow-up was 32.4 ± 17.5 months for surgical patients and 39.4 ± 14.8 months for percutaneous patients.
No major differences in preoperative variables were noted between groups. However, postprocedural complications including acute renal injury (26.2% vs. 4.9%; P<.001) and infection (11.9% vs. 2.4%; P=.03) were more common in the surgical group. At follow-up, all-cause mortality (30.6% vs. 23.8%; P=.53) and readmission for congestive HF (26.2% vs. 31.5%; P=.17) were similar between the treatment groups.
“In patients with indications for biventricular pacing and failed percutaneous leads, surgical lead placement likely will provide benefit to those patients,” the researchers concluded. “Importantly, surgical lead placement following failed percutaneous attempt is justified, as surgical leads confer similar functional benefits, short and long-term survival and readmission rates for congestive HF compared to primary percutaneous LV lead placement.”
Ailawadi G. Heart Rhythm. 2010;7:619-625.
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