Requirement for coronary sinus lead interventions and effectiveness of endovascular replacement during long-term follow-up after implantation of a resynchronization device.

AIMS The aim of this study was to assess the requirement for coronary sinus (CS) lead intervention after cardiac resynchronization therapy (CRT) and to evaluate the effectiveness of endovascular replacement. METHODS AND RESULTS All patients receiving a CRT device with CS lead in the Leiden University Medical Center in the period from 1999 to 2007 were prospectively evaluated and followed. Five hundred and seventy-seven patients were successfully implanted with a CRT device. Nine (1.6%) patients were lost to follow-up. The remaining 568 patients were included in the analysis. During a median follow-up time of 645 days (inter-quartile range, 260-1148), 7% of the patients required a CS lead intervention. Cause of the intervention was an elevated threshold (n = 13), loss of capture (n = 20), or intractable phrenic nerve stimulation (n = 6). Fifteen patients (38%) required a CS lead intervention before first scheduled follow-up (2 months after implantation). Thirteen patients (33%) warranted a CS lead intervention more than 6 months after implantation. The first endovascular replacement was successful in 86% (32 of 37), whereas a second endovascular approach failed in 66% (2 of 3). CONCLUSION The long-term requirement for CS lead interventions is 7%. Endovascular repositioning or replacement is successful in the majority of cases.