Clin Res Cardiol (2023). https://doi.org/10.1007/s00392-023-02302-4

Feasibility, Safety and Outcomes of Contrast-Free Cardiac Resynchronisation Therapy Device Implantation: a retrospective cohort comparison

A. Chouchane1, T. Storz2, L. Friedrich2, K. Knoll2, A. Fetcu2, M. Bock2, C. Schaarschmidt2, Y. Hartmann2, J. Syväri2, N. Erhard2, F. Bahlke2, F. Englert2, S. Lengauer3, M. Telishevska2, T. Reents2, T. Trenkwalder2, G. Heßling3, I. Deisenhofer3, C. Kolb2, C. Lennerz2

1Deutsches Herzzentrum München, München; 2Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München; 3Elektrophysiologie, Deutsches Herzzentrum München, München;

Background: Left ventricular lead (LVL) implantation can be challenging in Cardiac Resynchronization Therapy (CRT). Typically, contrast is used to facilitate the LVL implantation. However, the use of contrast is associated with potential risks and complications such as contrast nephropathy and allergic reactions. Case studies suggest feasibility of LVL implantation without coronary sinus venography. Purpose: We aimed to compare LVL implantation with and without contrast. Methods: We retrospectively analyzed 346 LVL implantations performed between 2017 and 2019. 167 procedures were performed without contrast (No-Contrast Group: NCG), and 179 were performed with contrast (Contrast Group: CG). The intervention duration, fluoroscopy duration, and dose were evaluated. The primary outcome was procedural success. The secondary outcomes were LVL position, LVL threshold value, QRS duration and LVEF. Safety outcomes included operative complications and lead revisions. Results: The LVL implantation success rate was 62.9% in the NCG group and 96.6% in the CG (Figure1). The procedure duration, fluoroscopy duration and the radiation dose were significantly less in the NCG (100.8±41.0min vs 131.1±50.0min (p<0.01), 15.7±11.2min vs 26.0±17.5min (p<0.01) and 475.3±422.7Gy*cm2 vs 897.3±779.1Gy*cm2 (p<0.01) respectively). The LVL threshold values were equivalent (mean 0.96±0.65V vs 1.05±0.65V, n.s.). The intraoperative complication rate was higher in the CG group: 9.5% in the CG versus 1.9% in the NCG (p=0.04). Intraoperative complications included coronary sinus dissection, perforation, mechanically induced arrhythmia and other respiratory or circulatory problems. The postoperative complication rates including pneumothorax, pericardial effusion, infection, ICU admission and the need for LVL revision were similar (9.5% in the NCG, 12.8% in the CG, p=0.55). The follow-up LVL threshold, QRS shortening and LVEF increase were also similar between groups (mean 1.11±0.55V vs 1.22±0.93V (p=0.62), -10.5±28.3ms vs -13.2±26.3ms (p=0.16) and 2.3±8% vs 4.1±8.4% (p=0.40) respectively). The intraprocedural complication rates in those who crossed over from the NCG to CG were similar to those in the CG (6.5% vs 9.5% respectively, p=0.6); the crossover was not associated with a longer procedure (131.8±46.8min vs 131.1±50.0min in the CG, p=0.9). Conclusion LVL implantation without contrast was associated with shorter intervention durations, shorter fluoroscopy durations and less radiation. Moreover, the contrast-free procedure is associated with lower intraoperative and postoperative complication rate compared to CG group. This contrast-free approach was successful in almost 2/3 of cases and when contrast was required, an initial contrast-free attempt did not result in increased adverse events. Thus, it is reasonable to consider an initial contrast-free approach to CRT implantation.

https://dgk.org/kongress_programme/ht2023/aP551.html