Characterization of the suitability of coronary venous anatomy for targeting left ventricular lead placement in patients undergoing cardiac resynchronization therapy

Abstract

Aims: Recent studies suggest differences in coronary venous anatomy between patients with ischaemic (I) and non-ischaemic (N) cardiomyopathy. We hypothesize that these differences may affect the potential for left ventricular (LV) lead targeting in patients undergoing cardiac resynchronization therapy. Methods and results: The retrograde contrast venograms were retrospectively reviewed in 133 patients (age 68 ± 9 years, 101 males). The quantity and distribution of veins were recorded as well as the final lead position. There were no major differences in the distribution of LV lead positions between I and N [posterior vein, 14.0 (I) vs. 15.8 (N); posterolateral vein, 21.1 vs. 18.4; lateral vein, 59.7 vs. 50.0; anterolateral vein, 3.5 vs. 13.2; P= NS]. Excluding the middle and great cardiac veins, in total only 59 of 133 patients had more than one suitable vein as potential targets for LV lead placement (I, 36.8 vs. N, 50.0; P = 0.16). Conclusion: Underlying aetiology does not affect the quantity and distribution of coronary veins available for LV lead placement. The limitations of venous anatomy restrict LV lead placement to a single vein with little scope for site selection in almost half of all the patients. Given these limitations, in many patients, prospective targeting of LV lead placement may require a direct surgical approach. © 2009 Published on behalf of the European Society of Cardiology. All rights reserved.