Is interventional technique better than the traditional over-the-wire method for the left ventricular lead implantation in cardiac resynchronization therapy?

Background Interventional-cardiac resynchronization therapy (I-CRT) for left ventricular lead (LVL) placement works as a supplement to the traditional over-the-wire-technique (T-CRT). It has been argued that I-CRT is a time-consuming and complicated procedure. Objective To investigate differences in procedure-related, peri- and post-operative and clinical endpoints between I-CRT and T-CRT. Method This single-center retrospective cohort-study included all consecutive patients receiving a CRT-pacemaker/defibrillator between January 1, 2012, and August 31, 2018. Patients underwent T-CRT from January 1, 2012, till June 1, 2015, and I-CRT from January 1, 2016, till August 31, 2018. We obtained data from patient-record-files, fluoroscopies and the Danish Pacemaker and ICD Register. Data were analysed using Wilcoxon-rank-sum/linear regression for continuous variables and Pearson’s Chi-squared/Fisher’s exact for categorical variables. Results An optimal LVL-placement was achieved in 82.7% in the I-CRT and 76.8% in the T-CRT group, respectively (p=0.015). In the I-CRT group 99.0% of LVLs were quadripolar versus 55.3% in the T-CRT group (p<0.001). Two or more leads were used during the procedure in 0.7% and 10.5% of all cases in the I-CRT and T-CRT group, respectively (p<0.001). Total implantation time was 81.0 min in the I-CRT group and 83.0 min in the T-CRT group (p=0.41). Time with catheters in the coronary sinus was 45.0 min versus 37.0 min for the I-CRT and T-CRT group, respectively (p<0.001). Conclusion I-CRT did not prolong total implantation time despite longer time with catheters in the CS. Additionally, I-CRT allowed more optimal LVL-placement, wider usage of quadripolar leads and fewer leads used during the procedure.