Modified snare technique improves left ventricular lead implant success for cardiac resynchronization therapy

Background Left ventricular (LV) lead placement is the most challenging aspect of cardiac resynchronization therapy (CRT) device implantation, with a failure rate of up to 10% due to complex coronary anatomies. We describe a modified snare technique for LV lead placement and evaluate its safety and...

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Published in:Journal of cardiovascular electrophysiology 2020-11, Vol.31 (11), p.2954-2963
Main Authors: Marques, Pedro, Nunes‐Ferreira, Afonso, António, Pedro S., Aguiar‐Ricardo, Inês, Lima da Silva, Gustavo, Guimarães, Tatiana, Bernardes, Ana, Santos, Igor, Pinto, Fausto J., Sousa, João
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Language:English
Subjects:
cardiac resynchronization therapy
efficacy
left ventricular lead
Mortality
responders
safety
snare technique
Ventricle
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cited_by cdi_FETCH-LOGICAL-c3530-954ddfe71f12a14891e866b1f8139439cd4f68e1806ed883586690fe4036d6463
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container_end_page 2963
container_issue 11
container_start_page 2954
container_title Journal of cardiovascular electrophysiology
container_volume 31
creator Marques, Pedro
Nunes‐Ferreira, Afonso
António, Pedro S.
Aguiar‐Ricardo, Inês
Lima da Silva, Gustavo
Guimarães, Tatiana
Bernardes, Ana
Santos, Igor
Pinto, Fausto J.
Sousa, João
description Background Left ventricular (LV) lead placement is the most challenging aspect of cardiac resynchronization therapy (CRT) device implantation, with a failure rate of up to 10% due to complex coronary anatomies. We describe a modified snare technique for LV lead placement and evaluate its safety and efficacy in cases when standard methods fail. Methods and Results A prospective study was conducted of patients indicated for a CRT implant. When LV lead delivery to the target vessel failed using standard techniques, a modified snare technique was employed. Patients were evaluated every 6 months. From 2015 to 2019, 566 CRTs were implanted (26.1% female, 72 ± 10.2 years old, follow‐up duration 18.9 ± 15.8 months). The standard LV implant technique failed in 94 cases (16.6%), of which the modified snare technique was successful in 92 (97.9%). There were no differences between the modified snare and standard techniques in the rates of 30‐day postimplant CRT all‐cause mortality (3.2% vs. 1.7%, p = .33), 4‐year all‐cause mortality (15.9% vs. 15.5%, p = .49), or major acute complications (7.4% vs. 3.8%, p = .12). However, the 4‐year procedural reintervention rate was lower with the modified snare technique (3.2% vs. 10.2%, p 
doi_str_mv 10.1111/jce.14750
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We describe a modified snare technique for LV lead placement and evaluate its safety and efficacy in cases when standard methods fail. Methods and Results A prospective study was conducted of patients indicated for a CRT implant. When LV lead delivery to the target vessel failed using standard techniques, a modified snare technique was employed. Patients were evaluated every 6 months. From 2015 to 2019, 566 CRTs were implanted (26.1% female, 72 ± 10.2 years old, follow‐up duration 18.9 ± 15.8 months). The standard LV implant technique failed in 94 cases (16.6%), of which the modified snare technique was successful in 92 (97.9%). There were no differences between the modified snare and standard techniques in the rates of 30‐day postimplant CRT all‐cause mortality (3.2% vs. 1.7%, p = .33), 4‐year all‐cause mortality (15.9% vs. 15.5%, p = .49), or major acute complications (7.4% vs. 3.8%, p = .12). However, the 4‐year procedural reintervention rate was lower with the modified snare technique (3.2% vs. 10.2%, p &lt; .05), specifically LV implant failure or dislodgement rates (0% vs. 5.3%, p &lt; .05), improving the response rate (71.8% vs. 55.1%, p &lt; .05). Conclusions For challenging coronary sinus anatomies that preclude LV lead placement by standard methods, this modified snare alternative was safe and effective, with comparable mortality and complications, but significantly lower procedural reintervention and higher response rates.</description><identifier>ISSN: 1045-3873</identifier><identifier>EISSN: 1540-8167</identifier><identifier>DOI: 10.1111/jce.14750</identifier><identifier>PMID: 32945049</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>cardiac resynchronization therapy ; efficacy ; left ventricular lead ; Mortality ; responders ; safety ; snare technique ; Ventricle</subject><ispartof>Journal of cardiovascular electrophysiology, 2020-11, Vol.31 (11), p.2954-2963</ispartof><rights>2020 Wiley Periodicals LLC</rights><rights>2020 Wiley Periodicals LLC.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3530-954ddfe71f12a14891e866b1f8139439cd4f68e1806ed883586690fe4036d6463</citedby><cites>FETCH-LOGICAL-c3530-954ddfe71f12a14891e866b1f8139439cd4f68e1806ed883586690fe4036d6463</cites><orcidid>0000-0003-2782-8214 ; 0000-0001-7054-0465 ; 0000-0003-3138-8354 ; 0000-0002-8034-4529 ; 0000-0002-9951-1104 ; 0000-0002-2836-9497</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27923,27924</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32945049$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marques, Pedro</creatorcontrib><creatorcontrib>Nunes‐Ferreira, Afonso</creatorcontrib><creatorcontrib>António, Pedro S.</creatorcontrib><creatorcontrib>Aguiar‐Ricardo, Inês</creatorcontrib><creatorcontrib>Lima da Silva, Gustavo</creatorcontrib><creatorcontrib>Guimarães, Tatiana</creatorcontrib><creatorcontrib>Bernardes, Ana</creatorcontrib><creatorcontrib>Santos, Igor</creatorcontrib><creatorcontrib>Pinto, Fausto J.</creatorcontrib><creatorcontrib>Sousa, João</creatorcontrib><title>Modified snare technique improves left ventricular lead implant success for cardiac resynchronization therapy</title><title>Journal of cardiovascular electrophysiology</title><addtitle>J Cardiovasc Electrophysiol</addtitle><description>Background Left ventricular (LV) lead placement is the most challenging aspect of cardiac resynchronization therapy (CRT) device implantation, with a failure rate of up to 10% due to complex coronary anatomies. We describe a modified snare technique for LV lead placement and evaluate its safety and efficacy in cases when standard methods fail. Methods and Results A prospective study was conducted of patients indicated for a CRT implant. When LV lead delivery to the target vessel failed using standard techniques, a modified snare technique was employed. Patients were evaluated every 6 months. From 2015 to 2019, 566 CRTs were implanted (26.1% female, 72 ± 10.2 years old, follow‐up duration 18.9 ± 15.8 months). The standard LV implant technique failed in 94 cases (16.6%), of which the modified snare technique was successful in 92 (97.9%). There were no differences between the modified snare and standard techniques in the rates of 30‐day postimplant CRT all‐cause mortality (3.2% vs. 1.7%, p = .33), 4‐year all‐cause mortality (15.9% vs. 15.5%, p = .49), or major acute complications (7.4% vs. 3.8%, p = .12). However, the 4‐year procedural reintervention rate was lower with the modified snare technique (3.2% vs. 10.2%, p &lt; .05), specifically LV implant failure or dislodgement rates (0% vs. 5.3%, p &lt; .05), improving the response rate (71.8% vs. 55.1%, p &lt; .05). Conclusions For challenging coronary sinus anatomies that preclude LV lead placement by standard methods, this modified snare alternative was safe and effective, with comparable mortality and complications, but significantly lower procedural reintervention and higher response rates.</description><subject>cardiac resynchronization therapy</subject><subject>efficacy</subject><subject>left ventricular lead</subject><subject>Mortality</subject><subject>responders</subject><subject>safety</subject><subject>snare technique</subject><subject>Ventricle</subject><issn>1045-3873</issn><issn>1540-8167</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp1kUtLAzEQx4MoPqoHv4AEvOhhbdI89yilvlC86HmJyYSm7KMmu5X66Y1WPQjOZYaZH39m5o_QMSUXNMd4YeGCciXIFtqngpNCU6m2c024KJhWbA8dpLQghDJJxC7aY5OSC8LLfdQ8dC74AA6n1kTAPdh5G14HwKFZxm4FCdfge7yCto_BDrWJuWHc57g2bY_TYC2khH0XsTXRBWNxhLRu7Tx2bXg3feha3M8hmuX6EO14Uyc4-s4j9Hw1e5reFPeP17fTy_vCMsFIUQrunAdFPZ0YynVJQUv5Qr2mrOSstI57qYFqIsFpzUSelsQDJ0w6ySUbobONbj4h35L6qgnJQp03hm5I1YRzzpQWSmX09A-66IbY5u0yJRTXiue3jdD5hrKxSymCr5YxNCauK0qqTw-q7EH15UFmT74Vh5cG3C_58_QMjDfAW6hh_b9SdTedbSQ_ACr0kK4</recordid><startdate>202011</startdate><enddate>202011</enddate><creator>Marques, Pedro</creator><creator>Nunes‐Ferreira, Afonso</creator><creator>António, Pedro S.</creator><creator>Aguiar‐Ricardo, Inês</creator><creator>Lima da Silva, Gustavo</creator><creator>Guimarães, Tatiana</creator><creator>Bernardes, Ana</creator><creator>Santos, Igor</creator><creator>Pinto, Fausto J.</creator><creator>Sousa, João</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-2782-8214</orcidid><orcidid>https://orcid.org/0000-0001-7054-0465</orcidid><orcidid>https://orcid.org/0000-0003-3138-8354</orcidid><orcidid>https://orcid.org/0000-0002-8034-4529</orcidid><orcidid>https://orcid.org/0000-0002-9951-1104</orcidid><orcidid>https://orcid.org/0000-0002-2836-9497</orcidid></search><sort><creationdate>202011</creationdate><title>Modified snare technique improves left ventricular lead implant success for cardiac resynchronization therapy</title><author>Marques, Pedro ; Nunes‐Ferreira, Afonso ; António, Pedro S. ; Aguiar‐Ricardo, Inês ; Lima da Silva, Gustavo ; Guimarães, Tatiana ; Bernardes, Ana ; Santos, Igor ; Pinto, Fausto J. ; Sousa, João</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3530-954ddfe71f12a14891e866b1f8139439cd4f68e1806ed883586690fe4036d6463</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>cardiac resynchronization therapy</topic><topic>efficacy</topic><topic>left ventricular lead</topic><topic>Mortality</topic><topic>responders</topic><topic>safety</topic><topic>snare technique</topic><topic>Ventricle</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Marques, Pedro</creatorcontrib><creatorcontrib>Nunes‐Ferreira, Afonso</creatorcontrib><creatorcontrib>António, Pedro S.</creatorcontrib><creatorcontrib>Aguiar‐Ricardo, Inês</creatorcontrib><creatorcontrib>Lima da Silva, Gustavo</creatorcontrib><creatorcontrib>Guimarães, Tatiana</creatorcontrib><creatorcontrib>Bernardes, Ana</creatorcontrib><creatorcontrib>Santos, Igor</creatorcontrib><creatorcontrib>Pinto, Fausto J.</creatorcontrib><creatorcontrib>Sousa, João</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium &amp; Calcified Tissue Abstracts</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of cardiovascular electrophysiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Marques, Pedro</au><au>Nunes‐Ferreira, Afonso</au><au>António, Pedro S.</au><au>Aguiar‐Ricardo, Inês</au><au>Lima da Silva, Gustavo</au><au>Guimarães, Tatiana</au><au>Bernardes, Ana</au><au>Santos, Igor</au><au>Pinto, Fausto J.</au><au>Sousa, João</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Modified snare technique improves left ventricular lead implant success for cardiac resynchronization therapy</atitle><jtitle>Journal of cardiovascular electrophysiology</jtitle><addtitle>J Cardiovasc Electrophysiol</addtitle><date>2020-11</date><risdate>2020</risdate><volume>31</volume><issue>11</issue><spage>2954</spage><epage>2963</epage><pages>2954-2963</pages><issn>1045-3873</issn><eissn>1540-8167</eissn><abstract>Background Left ventricular (LV) lead placement is the most challenging aspect of cardiac resynchronization therapy (CRT) device implantation, with a failure rate of up to 10% due to complex coronary anatomies. We describe a modified snare technique for LV lead placement and evaluate its safety and efficacy in cases when standard methods fail. Methods and Results A prospective study was conducted of patients indicated for a CRT implant. When LV lead delivery to the target vessel failed using standard techniques, a modified snare technique was employed. Patients were evaluated every 6 months. From 2015 to 2019, 566 CRTs were implanted (26.1% female, 72 ± 10.2 years old, follow‐up duration 18.9 ± 15.8 months). The standard LV implant technique failed in 94 cases (16.6%), of which the modified snare technique was successful in 92 (97.9%). There were no differences between the modified snare and standard techniques in the rates of 30‐day postimplant CRT all‐cause mortality (3.2% vs. 1.7%, p = .33), 4‐year all‐cause mortality (15.9% vs. 15.5%, p = .49), or major acute complications (7.4% vs. 3.8%, p = .12). However, the 4‐year procedural reintervention rate was lower with the modified snare technique (3.2% vs. 10.2%, p &lt; .05), specifically LV implant failure or dislodgement rates (0% vs. 5.3%, p &lt; .05), improving the response rate (71.8% vs. 55.1%, p &lt; .05). Conclusions For challenging coronary sinus anatomies that preclude LV lead placement by standard methods, this modified snare alternative was safe and effective, with comparable mortality and complications, but significantly lower procedural reintervention and higher response rates.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32945049</pmid><doi>10.1111/jce.14750</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0003-2782-8214</orcidid><orcidid>https://orcid.org/0000-0001-7054-0465</orcidid><orcidid>https://orcid.org/0000-0003-3138-8354</orcidid><orcidid>https://orcid.org/0000-0002-8034-4529</orcidid><orcidid>https://orcid.org/0000-0002-9951-1104</orcidid><orcidid>https://orcid.org/0000-0002-2836-9497</orcidid></addata></record>
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subjects cardiac resynchronization therapy
efficacy
left ventricular lead
Mortality
responders
safety
snare technique
Ventricle
title Modified snare technique improves left ventricular lead implant success for cardiac resynchronization therapy
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