0000000000344937
AUTHOR
Luca Bontempi
Non-responders to cardiac resynchronization therapy: Insights from multimodality imaging and electrocardiography. A brief review
Background Cardiac resynchronization therapy (CRT) is a successful strategy for heart failure (HF) patients. The pre-requisite for the response is the evidence of electrical dyssynchrony on the surface electrocardiogram usually as left bundle branch block (LBBB). Non-response to CRT is a significant problem in clinical practice. Patient selection, inadequate delivery and sub-optimal left ventricle lead position may be important causes. Objectives In an effort to improve CRT response multimodality imaging (especially echocardiography, computed tomography and cardiac magnetic resonance) could play a decisive role and extensive literature has been published on the matter. However, we are so fa…
Active-fixation coronary sinus pacing lead extraction: A hybrid approach
Cardiac resynchronization therapy (CRT) can be considered as the standard treatment for patients suffering from heart failure (NYHA III–IV), severely reduced left ventricular (LV) function, and wide QRS complexes. Over the past years, the lead systems used to stimulate the left ventricle have evolved technically from epicardial approaches to a transvenous access accompanied by a significant reduction of procedure-related complication rates [1]. However, even today, LV dislodgement rates ranging 5–10% and the instability of thresholds over time remain the greatest challenges with transvenous LV leads in CRT. Therefore, a special LV lead utilizing active fixation (the Attain StarFix® active f…
Jugular pacing lead extraction with laser sheath: a case report.
Over the past 20 years, the number of patients with pacemakers (PM) or implantable cardioverter defibrillators has risen markedly; consequently, an increasing number of lead-removal procedures have become necessary. A 64-year-old woman presenting with an infected device pocket and positive bacterial cultures ( Staphylococcus aureus ) was admitted to our department for lead removal; in 1991, she underwent VVI PM implantation for atrioventricular II degree Mobitz 1 block, and a unipolar lead was introduced via the left jugular vein. The procedure was performed in our Electrophysiology Lab with a cardiac surgeon on standby, using an excimer laser system emitting the energy at the tip of a flex…