Mid-term follow up of thromboembolic complications in left ventricular endocardial cardiac resynchronization therapy

作者：Rademakers Leonard M^*; van Gelder Berry M; Scheffer Mike G; Bracke Frank A

来源：Heart Rhythm, 2014, 11(4): 609-613.

DOI：10.1016/j.hrthm.2014.01.031

• Cardiac resynchronization therapy
• Endocardial left ventricular lead placement
• Thromboembolic risks
• Cerebrovascular accident
• Stroke

BACKGROUND Endocardial left ventricular (LV) pacing for cardiac resynchronization therapy (CRT) has been proposed as an alternative to traditional LV transvenous epicardial pacing with equal or superior cardiac performance. The risks of cerebral thromboembolism and possible interference with mitral valve function moderate its clinical application.
OBJECTIVE The purpose of this study was to investigate cerebral thromboembolic complications after LV endocardial lead placement. Mitral regurgitation (MR) was the secondary outcome measure.
METHODS CRT candidates with a failed coronary sinus approach or nonresponders to conventional CRT underwent endocardial LV lead implantation (45 atrial transseptal, 6 transapical). Coumarin was prescribed with a targeted international normalized ratio between 3.5 and 4.5. Patient records were checked and general practitioners were contacted regarding cerebral thromboembolic complications. MR was evaluated by echocardiography at baseline and after 6 months.
RESULTS In 7 patients, 6 ischemic strokes and 2 transient ischemic attacks occurred, corresponding to 6.1 thromboembolic events per 100 patient-years (95% confidence interval 3.4-15.8). One patient refused hospital admission; all other patients had a subtherapeutic anticoagulation Level at the time of the event. No major bleeding complications occurred. There was no change in the grade of MR (grade 2, P = .727) after 6 months.
CONCLUSION Endocardial LV lead placement in patients with advanced heart failure is associated with thromboembolic risk. However, all but 1 patient had a subtherapeutic level of anticoagulation. Endocardial LV lead placement is not associated with aggravation of MR.

• 出版日期2014-4