Preoperative Prediction of Optimal Method and Site of Left Ventricular Electrode Implantation

Abstract

We present a clinical case of cardiac resynchronization device implantation in a patient with a zone of late left ventricular activation in the area of the anterior coronary sinus vein, which, however, was unsuitable for endovascular implantation and stable electrode placement in it. This anatomical feature was diagnosed at the outpatient stage using a noninvasive mapping technique. Using this approach, we were able to understand that an epicardial electrode implantation, instead of traditional endovascular implantation of the left ventricular electrode through the coronary sinus vein, is indicated for the patient. Targeted implantation of an epicardial electrode in the area of interest on the epicardial surface of the left ventricle in the basal part of the anterolateral wall allowed achieving a complete clinical response to resynchronization therapy.

Keywords

Left ventricular lead implantation / noninvasive mapping / cardiac resynchronization therapy / case report

References

[1] Glikson M, Nielsen JC, Kronborg MB, et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Eur Heart J. 2021;42(35):3427–3520. DOI: 10.1093/eurheartj/ehab364.

[2] Glikson M., Nielsen J.C., Kronborg M.B., et al. 2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy // Eur Heart J. 2021. Vol. 42, No. 35. P. 3427–3520. DOI: 10.1093/eurheartj/ehab364.

[3] Ellenbogen КА, Kay GN, Wilkoff BL, editors. Device therapy for congestive heart failure. 2nd ed. USA: Saunders, 2004. P. 157–158.

[4] Ellenbogen К.А., Kay G.N., Wilkoff B.L., editors. Device therapy for congestive heart failure. 2nd ed. USA: Saunders, 2004. P. 157–158.

[5] Gras D, Leon AR, Fisher WG, Abraham WT. The road to successful CRT implantation. USA: Blackwell Futura, 2004. P. 27–31. DOI: 10.1002/9780470751411

[6] Gras D., Leon A.R., Fisher W.G., Abraham W.T. The road to successful CRT implantation. USA: Blackwell Futura, 2004. P. 27–31. DOI: 10.1002/9780470751411

[7] Zubarev S, Chmelevsky M, Potyagaylo D, et al. Noninvasive electrocardiographic imaging with magnetic resonance tomography in candidates for cardiac resynchronization therapy. Comput Cardiol. 2019;46:397. DOI: 10.23919/CinC49843.2019.9005803

[8] Zubarev S., Chmelevsky M., Potyagaylo D., et al. Noninvasive electrocardiographic imaging with magnetic resonance tomography in candidates for cardiac resynchronization therapy // Comput Cardiol. 2019. Vol. 46. ID 397. DOI: 10.23919/CinC49843.2019.9005803

[9] Stepanova VV, Stovpyuk OF, Karev EA, et al. Cardiac resynchronisation therapy in an adult patient with long-term right ventricular pacing due to congenital complete atrioventricular block. Annals of arrhythmology. 2021;18(3):154–161. (In Russ.). DOI: 10.15275/annaritmol.2021.3.4

[10] Степанова В.В., Стовпюк О.Ф., Карев Е.А., и др. Ресинхронизирующая терапия у взрослого пациента с длительным стажем правожелудочковой стимуляции вследствие врожденной полной атриовентрикулярной блокады // Анналы аритмологии. 2021. Т. 18, № 3. C. 154–161. DOI: 10.15275/annaritmol.2021.3.4

[11] Revishvili AS, Wissner E, Lebedev DS, et al. Validation of the mapping accuracy of a novel non-invasive epicardial and endocardial electrophysiology system. Europace. 2015;17(8):1282–1288. DOI:10.1093/europace/euu339

[12] Revishvili A.S., Wissner E., Lebedev D.S., et al. Validation of the mapping accuracy of a novel non-invasive epicardial and endocardial electrophysiology system // Europace. 2015. Vol. 17, No. 8. P. 1282–1288. DOI:10.1093/europace/euu339

RIGHTS & PERMISSIONS

Stepanova V.V., Marinin V.A., Zubarev S.V.