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Jean-jacques Blanc - One of the best experts on this subject based on the ideXlab platform.
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Left Ventricular Pacing in patients with congestive heart failure.
Indian pacing and electrophysiology journal, 2006Co-Authors: Yves Etienne, Marjaneh Fatemi, Jean-jacques BlancAbstract:Cardiac resynchronisation therapy (CRT) using biVentricular (BIV) Pacing has proved its effectiveness to correct myocardial asynchrony and improve clinical status of patients with severe congestive heart failure (CHF) and widened QRS. Despite a different effect on Left Ventricular electrical dispersion, Left uniVentricular (LV) Pacing is able to achieve the same mechanical synchronisation as BIV Pacing in experimental studies and in humans. This results in clinical benefits of LV Pacing at mid-term follow-up, with significant improvement in functional class, quality of life and exercise tolerance at the same extent as those observed with BIV stimulation in non randomised studies. Furthermore these benefits are obtained at lesser costs and with conventional dual-chamber devices. However, LV Pacing has to be compared to BIV Pacing in randomised trials before being definitely considered as a cost-effective alternative to BIV Pacing.
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Effect of Left Ventricular function on long-term Left Ventricular Pacing and sensing threshold.
Journal of Interventional Cardiac Electrophysiology, 2003Co-Authors: Cannas Yu, Vince Paul, Giuseppe Boriani, Andreas Schuchert, Klaus Malinowski, Jean-jacques BlancAbstract:Background: The effect of Left Ventricular (LV) systolic function on the long-term Left Ventricular Pacing and sensing threshold is unclear.
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long term Left Ventricular Pacing assessment and comparison with biVentricular Pacing in patients with severe congestive heart failure
Journal of the American College of Cardiology, 2001Co-Authors: A Touiza, Jacques Mansourati, Martine Gilard, Y Etienne, Marjaneh Fatemi, Jean-jacques BlancAbstract:OBJECTIVE: The purpose of this study is to report prospectively the results of six-month follow-up of permanent Left Ventricular (LV) based Pacing in patients with severe congestive heart failure (CHF) and Left bundle branch block (LBBB). BACKGROUND: Left Ventricular Pacing alone has been demonstrated to result in identical improvement compared to biVentricular Pacing (BiV) during acute hemodynamic evaluation in patients with advanced CHF and LBBB. However, to our knowledge, the clinical outcome during permanent LV Pacing alone versus BiV Pacing mode has not been evaluated. METHODS: Pacing configuration (LV or BiV) was selected according to the physician's preference. Patient evaluation was performed at baseline and at six months. RESULTS: Thirty-three patients with advanced CHF and LBBB were included. Baseline characteristics of LV (18 patients) and BiV (15 patients) Pacing groups were similar. During the six-month follow-up period, seven patients died three BiV and four LV). In the surviving patients at 6 months, 8 of 14 patients in the LV group and 9 of 12 in the BiV group were in New York Heart Association class I or II (p = 0.39). No significant difference was observed between the two groups in terms of objective parameters except for LV end-diastolic diameter decrease (-4.4 mm in BiV group vs. -0.7 mm in LV group; p = 0.04). CONCLUSION: At six-month follow-up, a trend toward improvement was observed in objective parameters in patients with severe CHF and LBBB following LV-based Pacing. The two Pacing modes (LV and BiV) were associated with almost equivalent improvement of subjective and objective parameters.
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adverse events with transvenous Left Ventricular Pacing in patients with severe heart failure early experience from a single centre
Europace, 2001Co-Authors: Valerie Vallsbertault, Jacques Mansourati, Martine Gilard, Y Etienne, S Munier, Jean-jacques BlancAbstract:Aims Assessment of complications following implantation of transvenous Ventricular electrodes to pace the Left ventricle. Methods and Results Twenty-eight patients with severe cardiac failure and Left bundle branch block were prospectively followed for adverse effects of implantation of a Left Ventricular transvenous Pacing system. Immediate followup was associated with loss of Left Ventricular Pacing in nine patients (32%). This was due to lead dislodgement in four cases (corrected by re-operation in three of these cases), and due to increased threshold in five cases (corrected by programming a higher Pacing amplitude in all five cases, but 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 patients. Pericardial effusion, new significant Ventricular arrhythmias or other adverse effects were not observed. After a mean follow-up of 16±9·2 months, 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 sinus is feasible without serious adverse effects during the first month. The only frequent adverse event was lead dislodgement; a finding which emphasizes the need for development of specially designed leads for this application.
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Assessment of Left Ventricular Pacing in patients with severe cardiac failure after atrioVentricular node ablation and right Ventricular Pacing for permanent atrial fibrillation.
Europace, 1999Co-Authors: Jean-jacques Blanc, Yves Etienne, Martine GilardAbstract:In patients with functionally poorly tolerated permanent atrial fibrillation (AF) radiofrequency (RF) catheter ablation of the atrioVentricular (AV) node is considered a potential treatment. However, the treatment is established in patients with haemodynamically deleterious AF despite optimal medical therapy. After this procedure, permanent Ventricular Pacing is mandatory with an electrode implanted in the right Ventricular apex. However, in some patients, restoration of a lower and regular Ventricular rhythm does not improve symptoms of cardiac failure, and in some patients the haemodynamic status deteriorates. Finally, in some others after a period of well-being symptoms of severe cardiac failure recur. In these cases, therapeutic options are very limited: modifications in medical treatment have usually already been shown to be ineffective. Cardiac transplantation is very restricted in patients older than 60 years due to the shortage of donor hearts and other options are unrealistic either because they are experimental or ineffective. Recently, Left Ventricular Pacing has been shown to be effective in improving the functional status of patients with end-stage cardiac failure. The aim of the present study was to evaluate the preliminary results of this procedure in patients with severe cardiac failure after AV node ablation for permanent AF.
Jacques Mansourati - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Severe Heart Failure: Is Left Ventricular Pacing Alone Enough or Do We Need BiVentricular Pacing?
Cardiac Arrhythmias 1999 - Vol.1, 2020Co-Authors: J. J. Blanc, Yves Etienne, Jacques Mansourati, Martine GilardAbstract:In patients with severe heart failure in spite of “optimal” drug treatment, interventions remain limited. Adjustment of drug treatment may be helpful but its benefit is generally of short duration and the problem is merely delayed; heart transplant is restricted to a few patients due to the small numbers of donors and other non-pharmacological treatments remain investigational (mechanical assistance device) or questionnable (cardiomyoplasty). Since the beginning of the 1990s, many efforts have been directed toward the use of Pacing in such situations. After a brief period of hope [1], it has been demonstrated that right apical Pacing has no or little effectiveness in patients with severe heart failure [2–4]. In fact, only some of those with a very long PR interval achieved significant improvement of their symptoms with this Pacing site [5]. Other right Ventricular Pacing sites were evaluated but in most of the patients remained unsuccessful [6, 7]. In 1994, a brief paper was published reporting that the adjoining of a Left Ventricular Pacing site to the right one led to significant improvement in patients with end-stage heart failure [8]. This observation gave the impetus for a flourishing field of research. It was initially thought that hemodynamic improvement was exclusively a direct consequence of the resynchronization of the two ventricles, as this procedure was only effective in patients with Left bundle branch block [9]. It rapidly appeared that this explanation was totally insufficient, as we demontrated in acute hemodynamic studies that Left Ventricular Pacing alone was at least as effective as biVentricular Pacing [10]. The aim of the present paper is to summarize our present knowledge on Left Ventricular Pacing alone. However, we should remained cautious, as developments in this field are coming quickly and it is difficult to assume that the present data will be confirmed by ongoing studies.
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long term Left Ventricular Pacing assessment and comparison with biVentricular Pacing in patients with severe congestive heart failure
Journal of the American College of Cardiology, 2001Co-Authors: A Touiza, Jacques Mansourati, Martine Gilard, Y Etienne, Marjaneh Fatemi, Jean-jacques BlancAbstract:OBJECTIVE: The purpose of this study is to report prospectively the results of six-month follow-up of permanent Left Ventricular (LV) based Pacing in patients with severe congestive heart failure (CHF) and Left bundle branch block (LBBB). BACKGROUND: Left Ventricular Pacing alone has been demonstrated to result in identical improvement compared to biVentricular Pacing (BiV) during acute hemodynamic evaluation in patients with advanced CHF and LBBB. However, to our knowledge, the clinical outcome during permanent LV Pacing alone versus BiV Pacing mode has not been evaluated. METHODS: Pacing configuration (LV or BiV) was selected according to the physician's preference. Patient evaluation was performed at baseline and at six months. RESULTS: Thirty-three patients with advanced CHF and LBBB were included. Baseline characteristics of LV (18 patients) and BiV (15 patients) Pacing groups were similar. During the six-month follow-up period, seven patients died three BiV and four LV). In the surviving patients at 6 months, 8 of 14 patients in the LV group and 9 of 12 in the BiV group were in New York Heart Association class I or II (p = 0.39). No significant difference was observed between the two groups in terms of objective parameters except for LV end-diastolic diameter decrease (-4.4 mm in BiV group vs. -0.7 mm in LV group; p = 0.04). CONCLUSION: At six-month follow-up, a trend toward improvement was observed in objective parameters in patients with severe CHF and LBBB following LV-based Pacing. The two Pacing modes (LV and BiV) were associated with almost equivalent improvement of subjective and objective parameters.
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adverse events with transvenous Left Ventricular Pacing in patients with severe heart failure early experience from a single centre
Europace, 2001Co-Authors: Valerie Vallsbertault, Jacques Mansourati, Martine Gilard, Y Etienne, S Munier, Jean-jacques BlancAbstract:Aims Assessment of complications following implantation of transvenous Ventricular electrodes to pace the Left ventricle. Methods and Results Twenty-eight patients with severe cardiac failure and Left bundle branch block were prospectively followed for adverse effects of implantation of a Left Ventricular transvenous Pacing system. Immediate followup was associated with loss of Left Ventricular Pacing in nine patients (32%). This was due to lead dislodgement in four cases (corrected by re-operation in three of these cases), and due to increased threshold in five cases (corrected by programming a higher Pacing amplitude in all five cases, but 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 patients. Pericardial effusion, new significant Ventricular arrhythmias or other adverse effects were not observed. After a mean follow-up of 16±9·2 months, 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 sinus is feasible without serious adverse effects during the first month. The only frequent adverse event was lead dislodgement; a finding which emphasizes the need for development of specially designed leads for this application.
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a method for permanent transvenous Left Ventricular Pacing
Pacing and Clinical Electrophysiology, 1998Co-Authors: Jean-jacques Blanc, Jacques Mansourati, Martine Gilard, David G Benditt, Y Etienne, Keith G LurieAbstract:LV-based Pacing has recently been reported to be of benefit in patients with severe cardiac failure and Left bundle branch block. LV permanent Pacing has been reported using epicardial leads but the surgical mortality is excessive. A transvenous approach is now favored. In this regard, cannulation of the coronary sinus and of one of its tributaries using only the permanent electrode is feasible but technically challenging. We describe a “long guiding sheath” method using catheterization, and a long radiopaque and peelable sheath. Once the coronaiy sinus is cannulated with the electrophysiological catheter, the long sheath is advanced to the mid-part of the coronary sinus. The permanent Pacing electrode is then placed through the sheath and into a tributary of the coronary sinus. This method has been attempted in 10 patients and was successful in 8, with an average lead insertion time of 21 ± 5.5 minutes and an average fluoroscopic time of 11 ± 5.5 minutes. In conclusion, although transvenous Left Ventricular Pacing remains a challenge, the “long guiding sheath” approach appears to facilitate this procedure with both a high success rate and an acceptable procedure time.
Y Etienne - One of the best experts on this subject based on the ideXlab platform.
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long term Left Ventricular Pacing assessment and comparison with biVentricular Pacing in patients with severe congestive heart failure
Journal of the American College of Cardiology, 2001Co-Authors: A Touiza, Jacques Mansourati, Martine Gilard, Y Etienne, Marjaneh Fatemi, Jean-jacques BlancAbstract:OBJECTIVE: The purpose of this study is to report prospectively the results of six-month follow-up of permanent Left Ventricular (LV) based Pacing in patients with severe congestive heart failure (CHF) and Left bundle branch block (LBBB). BACKGROUND: Left Ventricular Pacing alone has been demonstrated to result in identical improvement compared to biVentricular Pacing (BiV) during acute hemodynamic evaluation in patients with advanced CHF and LBBB. However, to our knowledge, the clinical outcome during permanent LV Pacing alone versus BiV Pacing mode has not been evaluated. METHODS: Pacing configuration (LV or BiV) was selected according to the physician's preference. Patient evaluation was performed at baseline and at six months. RESULTS: Thirty-three patients with advanced CHF and LBBB were included. Baseline characteristics of LV (18 patients) and BiV (15 patients) Pacing groups were similar. During the six-month follow-up period, seven patients died three BiV and four LV). In the surviving patients at 6 months, 8 of 14 patients in the LV group and 9 of 12 in the BiV group were in New York Heart Association class I or II (p = 0.39). No significant difference was observed between the two groups in terms of objective parameters except for LV end-diastolic diameter decrease (-4.4 mm in BiV group vs. -0.7 mm in LV group; p = 0.04). CONCLUSION: At six-month follow-up, a trend toward improvement was observed in objective parameters in patients with severe CHF and LBBB following LV-based Pacing. The two Pacing modes (LV and BiV) were associated with almost equivalent improvement of subjective and objective parameters.
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adverse events with transvenous Left Ventricular Pacing in patients with severe heart failure early experience from a single centre
Europace, 2001Co-Authors: Valerie Vallsbertault, Jacques Mansourati, Martine Gilard, Y Etienne, S Munier, Jean-jacques BlancAbstract:Aims Assessment of complications following implantation of transvenous Ventricular electrodes to pace the Left ventricle. Methods and Results Twenty-eight patients with severe cardiac failure and Left bundle branch block were prospectively followed for adverse effects of implantation of a Left Ventricular transvenous Pacing system. Immediate followup was associated with loss of Left Ventricular Pacing in nine patients (32%). This was due to lead dislodgement in four cases (corrected by re-operation in three of these cases), and due to increased threshold in five cases (corrected by programming a higher Pacing amplitude in all five cases, but 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 patients. Pericardial effusion, new significant Ventricular arrhythmias or other adverse effects were not observed. After a mean follow-up of 16±9·2 months, 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 sinus is feasible without serious adverse effects during the first month. The only frequent adverse event was lead dislodgement; a finding which emphasizes the need for development of specially designed leads for this application.
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a method for permanent transvenous Left Ventricular Pacing
Pacing and Clinical Electrophysiology, 1998Co-Authors: Jean-jacques Blanc, Jacques Mansourati, Martine Gilard, David G Benditt, Y Etienne, Keith G LurieAbstract:LV-based Pacing has recently been reported to be of benefit in patients with severe cardiac failure and Left bundle branch block. LV permanent Pacing has been reported using epicardial leads but the surgical mortality is excessive. A transvenous approach is now favored. In this regard, cannulation of the coronary sinus and of one of its tributaries using only the permanent electrode is feasible but technically challenging. We describe a “long guiding sheath” method using catheterization, and a long radiopaque and peelable sheath. Once the coronaiy sinus is cannulated with the electrophysiological catheter, the long sheath is advanced to the mid-part of the coronary sinus. The permanent Pacing electrode is then placed through the sheath and into a tributary of the coronary sinus. This method has been attempted in 10 patients and was successful in 8, with an average lead insertion time of 21 ± 5.5 minutes and an average fluoroscopic time of 11 ± 5.5 minutes. In conclusion, although transvenous Left Ventricular Pacing remains a challenge, the “long guiding sheath” approach appears to facilitate this procedure with both a high success rate and an acceptable procedure time.
Christophe Leclercq - One of the best experts on this subject based on the ideXlab platform.
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alternative Left Ventricular Pacing approaches for optimal cardiac resynchronization therapy
Heart Rhythm, 2019Co-Authors: Vincent Galand, Jagmeet P Singh, Christophe LeclercqAbstract:Cardiac resynchronization therapy (CRT) improves mortality, morbidity, and quality of life in selected heart failure patients with severe Left Ventricular (LV) ejection fraction impairment. However, between 20% and 40% of device recipients do not benefit clinically from CRT. Indeed, some anatomic and technical difficulties are related to the coronary venous implantation site via the coronary sinus (CS). Additionally, electrical constraints have been described, and CS does not always correspond to the optimal LV lead position. In the last decade, engineers and physicians have worked together to overcome the challenging LV lead implantation, and various biVentricular Pacing alternatives have been developed to improve CRT response. In this review, we discuss the evolution from CS Pacing to wireless LV stimulation and His-bundle Pacing.
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six year experience of transvenous Left Ventricular lead implantation for permanent biVentricular Pacing in patients with advanced heart failure technical aspects
Heart, 2001Co-Authors: Christine Alonso, Christophe Leclercq, Revault F Dallonnes, Dominique Pavin, F Victor, P Mabo, Jeanclaude DaubertAbstract:BACKGROUND BiVentricular Pacing has been proposed as an adjuvant to optimal medical treatment in patients with drug refractory heart failure caused by chronic Left Ventricular systolic dysfunction and intraVentricular conduction delay. OBJECTIVE To assess the technical feasibility and long term results (over six years) of transverse Left Ventricular Pacing with the lead inserted into a tributary vein of the coronary sinus. SUBJECTS From August 1994 to February 2000, Left Ventricular lead implantation was attempted in 116 patients who were eligible for biVentricular Pacing (mean (SD) age 67 (9) years, New York Heart Association (NYHA) functional class III/IV, Left Ventricular ejection fraction 22 (6)%, QRS duration 185 (26) ms). RESULTS The overall implantation success rate was 88% (n = 102). A learning curve was indicated by a progressive increase in success from 61% early on to 98% in the last year. The mean Pacing threshold was 1.1 (0.7) V/0.5 ms at the time of implantation and increased slightly up to 1.9 (0.9) V/0.5 ms at the end of the follow up period (15 (13) months). The rate of acute and delayed Left Ventricular lead dislodgement decreased from 30% in the early years to 11% after 1999. During follow up, 19 patients required reoperation for delayed lead dislodgement or increase in Left Ventricular Pacing threshold (n = 15), phrenic nerve stimulation (n = 3), or infection (n = 3). CONCLUSIONS Transverse Left Ventricular Pacing through the coronary sinus is feasible and safe. The rate of implantation failure and of lead related problems has decreased greatly with increasing experience and with improvements in the equipment.
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permanent Left Ventricular Pacing with transvenous leads inserted into the coronary veins
Pacing and Clinical Electrophysiology, 1998Co-Authors: Claude J Daubert, Philippe Ritter, Philippe Mabo, Herve Le Breton, Daniel Gras, Christophe Leclercq, Arnaud Lazarus, J Mugica, Serge CazeauAbstract:This paper describes a preliminary experiment - conducted jointly by 2 centers - of permanent Left Ventricular Pacing using leads inserted by the transvenous route and through the coronary sinus into the cardiac veins of the Left ventricle free wall. The aim was to obtain permanent biVentricular Pacing in a totally endocavitary configuration in pattents with severe LV dysfunction and drug-refractory heart failure. Two types of leads were used: nonspecific unipolar leads at the beginning of the experiment, followed by leads specifically designed to be used in the coronary sinus in a second step. The electrode could be fitted in an adequate location in 35 of the 47 patients (75.4%), with a 1.15±0.7 V acute pactng threshold and 11.8±5.7 mV R wave amplitude. The success rate was significantly higher with the specific electrodes (81.8% vs 53,3%, p < 0.001). The Pacing and sensing thresholds upon implantation were not influenced by the type of lead or by the localization of the cardiac vein that was catheterized (great cardiac vein, lateral vein, postero-lateral or posterior vein, mid cardiac vein). In contrast, the Pacing threshold was significantly lower (0.8 ± 0.2 vs L8 ± 0.8 V; p = 0.002) and the R wave amplitude tended to be greater (13.1 ± 4.5 mV vs 9.3 ± 6.5 mV; p = 0.07) when the tip electrode could be inserted distally into the vein, by comparison with a proximal site near the ostium. At the end of follow-up (10.2 ± 8.7 months), 34 out of the 35 leads were still fully functional, with a chronic Pacing threshold of 1.8 ± 0.7 V and a R wave amplitude of 10.7 ± 6 mV. To conclude, permanent LV Pacing via the transvenous route is possible in most patients, with excellent safety and long-term results.
Martine Gilard - One of the best experts on this subject based on the ideXlab platform.
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Treatment of Severe Heart Failure: Is Left Ventricular Pacing Alone Enough or Do We Need BiVentricular Pacing?
Cardiac Arrhythmias 1999 - Vol.1, 2020Co-Authors: J. J. Blanc, Yves Etienne, Jacques Mansourati, Martine GilardAbstract:In patients with severe heart failure in spite of “optimal” drug treatment, interventions remain limited. Adjustment of drug treatment may be helpful but its benefit is generally of short duration and the problem is merely delayed; heart transplant is restricted to a few patients due to the small numbers of donors and other non-pharmacological treatments remain investigational (mechanical assistance device) or questionnable (cardiomyoplasty). Since the beginning of the 1990s, many efforts have been directed toward the use of Pacing in such situations. After a brief period of hope [1], it has been demonstrated that right apical Pacing has no or little effectiveness in patients with severe heart failure [2–4]. In fact, only some of those with a very long PR interval achieved significant improvement of their symptoms with this Pacing site [5]. Other right Ventricular Pacing sites were evaluated but in most of the patients remained unsuccessful [6, 7]. In 1994, a brief paper was published reporting that the adjoining of a Left Ventricular Pacing site to the right one led to significant improvement in patients with end-stage heart failure [8]. This observation gave the impetus for a flourishing field of research. It was initially thought that hemodynamic improvement was exclusively a direct consequence of the resynchronization of the two ventricles, as this procedure was only effective in patients with Left bundle branch block [9]. It rapidly appeared that this explanation was totally insufficient, as we demontrated in acute hemodynamic studies that Left Ventricular Pacing alone was at least as effective as biVentricular Pacing [10]. The aim of the present paper is to summarize our present knowledge on Left Ventricular Pacing alone. However, we should remained cautious, as developments in this field are coming quickly and it is difficult to assume that the present data will be confirmed by ongoing studies.
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long term Left Ventricular Pacing assessment and comparison with biVentricular Pacing in patients with severe congestive heart failure
Journal of the American College of Cardiology, 2001Co-Authors: A Touiza, Jacques Mansourati, Martine Gilard, Y Etienne, Marjaneh Fatemi, Jean-jacques BlancAbstract:OBJECTIVE: The purpose of this study is to report prospectively the results of six-month follow-up of permanent Left Ventricular (LV) based Pacing in patients with severe congestive heart failure (CHF) and Left bundle branch block (LBBB). BACKGROUND: Left Ventricular Pacing alone has been demonstrated to result in identical improvement compared to biVentricular Pacing (BiV) during acute hemodynamic evaluation in patients with advanced CHF and LBBB. However, to our knowledge, the clinical outcome during permanent LV Pacing alone versus BiV Pacing mode has not been evaluated. METHODS: Pacing configuration (LV or BiV) was selected according to the physician's preference. Patient evaluation was performed at baseline and at six months. RESULTS: Thirty-three patients with advanced CHF and LBBB were included. Baseline characteristics of LV (18 patients) and BiV (15 patients) Pacing groups were similar. During the six-month follow-up period, seven patients died three BiV and four LV). In the surviving patients at 6 months, 8 of 14 patients in the LV group and 9 of 12 in the BiV group were in New York Heart Association class I or II (p = 0.39). No significant difference was observed between the two groups in terms of objective parameters except for LV end-diastolic diameter decrease (-4.4 mm in BiV group vs. -0.7 mm in LV group; p = 0.04). CONCLUSION: At six-month follow-up, a trend toward improvement was observed in objective parameters in patients with severe CHF and LBBB following LV-based Pacing. The two Pacing modes (LV and BiV) were associated with almost equivalent improvement of subjective and objective parameters.
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adverse events with transvenous Left Ventricular Pacing in patients with severe heart failure early experience from a single centre
Europace, 2001Co-Authors: Valerie Vallsbertault, Jacques Mansourati, Martine Gilard, Y Etienne, S Munier, Jean-jacques BlancAbstract:Aims Assessment of complications following implantation of transvenous Ventricular electrodes to pace the Left ventricle. Methods and Results Twenty-eight patients with severe cardiac failure and Left bundle branch block were prospectively followed for adverse effects of implantation of a Left Ventricular transvenous Pacing system. Immediate followup was associated with loss of Left Ventricular Pacing in nine patients (32%). This was due to lead dislodgement in four cases (corrected by re-operation in three of these cases), and due to increased threshold in five cases (corrected by programming a higher Pacing amplitude in all five cases, but 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 patients. Pericardial effusion, new significant Ventricular arrhythmias or other adverse effects were not observed. After a mean follow-up of 16±9·2 months, 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 sinus is feasible without serious adverse effects during the first month. The only frequent adverse event was lead dislodgement; a finding which emphasizes the need for development of specially designed leads for this application.
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Assessment of Left Ventricular Pacing in patients with severe cardiac failure after atrioVentricular node ablation and right Ventricular Pacing for permanent atrial fibrillation.
Europace, 1999Co-Authors: Jean-jacques Blanc, Yves Etienne, Martine GilardAbstract:In patients with functionally poorly tolerated permanent atrial fibrillation (AF) radiofrequency (RF) catheter ablation of the atrioVentricular (AV) node is considered a potential treatment. However, the treatment is established in patients with haemodynamically deleterious AF despite optimal medical therapy. After this procedure, permanent Ventricular Pacing is mandatory with an electrode implanted in the right Ventricular apex. However, in some patients, restoration of a lower and regular Ventricular rhythm does not improve symptoms of cardiac failure, and in some patients the haemodynamic status deteriorates. Finally, in some others after a period of well-being symptoms of severe cardiac failure recur. In these cases, therapeutic options are very limited: modifications in medical treatment have usually already been shown to be ineffective. Cardiac transplantation is very restricted in patients older than 60 years due to the shortage of donor hearts and other options are unrealistic either because they are experimental or ineffective. Recently, Left Ventricular Pacing has been shown to be effective in improving the functional status of patients with end-stage cardiac failure. The aim of the present study was to evaluate the preliminary results of this procedure in patients with severe cardiac failure after AV node ablation for permanent AF.
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a method for permanent transvenous Left Ventricular Pacing
Pacing and Clinical Electrophysiology, 1998Co-Authors: Jean-jacques Blanc, Jacques Mansourati, Martine Gilard, David G Benditt, Y Etienne, Keith G LurieAbstract:LV-based Pacing has recently been reported to be of benefit in patients with severe cardiac failure and Left bundle branch block. LV permanent Pacing has been reported using epicardial leads but the surgical mortality is excessive. A transvenous approach is now favored. In this regard, cannulation of the coronary sinus and of one of its tributaries using only the permanent electrode is feasible but technically challenging. We describe a “long guiding sheath” method using catheterization, and a long radiopaque and peelable sheath. Once the coronaiy sinus is cannulated with the electrophysiological catheter, the long sheath is advanced to the mid-part of the coronary sinus. The permanent Pacing electrode is then placed through the sheath and into a tributary of the coronary sinus. This method has been attempted in 10 patients and was successful in 8, with an average lead insertion time of 21 ± 5.5 minutes and an average fluoroscopic time of 11 ± 5.5 minutes. In conclusion, although transvenous Left Ventricular Pacing remains a challenge, the “long guiding sheath” approach appears to facilitate this procedure with both a high success rate and an acceptable procedure time.