Percutaneous mitral annuloplasty device leaves free access to cardiac veins for resynchronization therapy

Abstract

OBJECTIVES: To assess the feasibility to place a left ventricular lead into the coronary sinus following percutaneous mitral annuloplasty. BACKGROUND: Percutaneous coronary sinus-based mitral annuloplasty may reduce functional mitral regurgitation in chronic systolic heart failure. However, concerns have been raised whether the placement of an annular remodeling device in the coronary sinus might preclude subsequent lead placement for resynchronization therapy (CRT). METHODS: Three patients with ischemic cardiomyopathy included in the AMADEUS trial underwent CRT 7 to 8 months after implantation of a mitral valve annuloplasty device. RESULTS: Fluoroscopy and control coronary angiography revealed a stable position of the annuloplasty device without any compromise of coronary blood flow. Intravascular ultrasound of the coronary sinus excluded any thrombus formation and demonstrated smooth endothelialization of the annular remodeling device. Access of the coronary sinus and placement of the left ventricular lead into a posterolateral cardiac vein was not at all compromised by the mitral valve annuloplasty device in any patient. CONCLUSIONS: Positioning a left ventricular pacing lead for CRT is feasible after permanent implantation of a coronary sinus-based mitral annuloplasty device in patients with dilated cardiomyopathy.