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Choice of a surgical access at implantation of left ventricular electrode for continuous pacing in treatment of CHF

Osadchiy A. M., Marinin V. A., Lebedev D. S.
Federal State Budgetary Institution, “North-West Federal Medical Research Center” of the RF Ministry of Health Care, Akkuratova 2, St.-Petersburg 197341

Keywords: cardiac veins, continious coronary angiography, cardiac resynchronization therapy, CHF, pacing

DOI: 10.18087/rhfj.2012.1.1644

Relevance. The recent years, a relatively new, proved and effective method of CHF correction is used in the treatment of patients – cardiac resynchronization therapy (CRT), endpoint clinical effect is missing in a third of patients, which sets the necessity of further studies. Objective. Study the possibility of results improvement of surgical treatment of cardiac conduction disorders by the correction of LV dyssinchrony against permanent pacing. Materials and methods. 257 patients were enrolled to the study, of which 150 patients with CHF underwent surgical correction of bradyarrhythmias by implantation of pacemakers through different accesses, and 107 patients underwent diagnostic continuous coronary angiography with study of venous phase concerning CHD. Epicordial electrodes through the surgical access were implanted to the patients who underwent treatment of bradyarrhythmias and correction of CHF (mini thoracotomy, midline sternotomy) – 20 patients, endocardial right ventricular electrodes– 70 patients (IVS and RV apex) and CRT endocardial devices– 60 patients. Patients were divided to 2 groups: A – endovascular electrode, B – electrode implantation after cardiac surgery (CS). Taking into account position of ventricular electrode (VE), patients were divided into 3 groups: Group 1 – VE in the RV apix, Group 2 – VE in IVS, Group 3 – VE sewn epicardially to the ventricles after the 1st phase of CS. Depending on occurrence of CHD, patients were divided to 2 groups: Group 1 – with confirmed CHD and Group 2 – without CHD. The influence of enlarged chambers of heart on the anatomy of cardiac veins was assessed in these groups. Venous anatomy was studied taking into account an area of MI. The patients were followed up 17±1.9 months at the average. Results. Epicardial biventricular pacing is applicable and safe even without dyssinchrony. Before CRT device implantation, patient’s veins anatomy must be studies and optimal position of an electrode must be determined (tissue echoCG). Continuous CAG allows to study anatomy of cardiac veins and select a surgical access (endovascular, thoracoscopic) taking into account echoCG data.
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Osadchiy A. M., Marinin V. A., Lebedev D. S. Choice of a surgical access at implantation of left ventricular electrode for continuous pacing in treatment of CHF. Russian Heart Failure Journal. 2012;13(1):46-52

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