Advancing cardiac resynchronization therapy techniques: evaluating safety, efficacy, and long-term outcomes with percutaneous coronary venoplasty and balloon capping.

Abstract

Background: Cardiac resynchronization therapy (CRT) is a cornerstone treatment for heart failure patients with wide QRS complexes. Optimal left ventricular (LV) lead placement is crucial for CRT success but can be challenging due to anatomical complexities within the coronary venous system. This study evaluates the safety, efficacy, and long-term outcomes of percutaneous coronary venoplasty (PCV) and a novel "balloon capping" technique for overcoming challenging coronary venous anatomies.

Methods: We retrospectively analyzed 44 CRT patients, divided into two groups: those undergoing PCV-assisted LV lead implantation (n = 15) and those receiving conventional CRT implantation (n = 29). A novel "balloon capping" technique was employed in select cases to navigate tortuous venous pathways. Baseline characteristics, procedural details, and clinical outcomes, including changes in ejection fraction (EF), QRS duration, and NYHA class, were compared. The Kaplan-Meier and Cox regression analyses evaluated long-term outcomes.

Results: PCV was associated with successful LV lead placement in all cases, despite significantly smaller target vessel diameters (p < 0.001). ΔEF was significantly greater in the PCV group (p = 0.030), indicating improved CRT response. Balloon capping was employed in 11.4% of cases, achieving comparable procedural success and clinical outcomes. There were no significant differences in mortality or hospitalizations between groups.

Conclusion: CRT was associated with significant improvements in ΔEF, with PCV facilitating successful LV lead placement in anatomically challenging cases. Larger studies are needed to confirm these findings and explore their long-term clinical implications.