Analysis of the Difficulties in the Operation of Biventricular Pacing

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Background: Cardiac resynchronization therapy is an important option for the treatment of heart failure. But it was reported that unsuccess rate of the operation was 3–7%. Purpose: Aim of this study was to clarify the factors of difficulties in the operation of biventricular pacing. Methods: We implanted 60 biventricular pacing devices from February 2007 to May 2011 in our hospital. Our average operation time was 118 minutes (50–220 min.). We divided our patients (pts.) into two groups by the operation time. L group's operation time was over 180 min and N group's time was less than 180 min. Results: L group consisted of 8 patients. Average operation times were 193 and 107 min respectively. Female gender was more in L group (75% vs. 44.2%). Mode of VVI pacing (chronic Atrial Fibrillation) was in 7 patients in L group. Main causes of long operation time were difficulties in coronary sinus (CS) cannulation (6/8) and the selection of appropriate branches (3/8). In one patient we could not insert the LV lead due to Valve of Vieussens and did ICD implantation reluctantly. Complications in L group occurred in 2 pts. One was dissection of CS and the other was pneumothorax. Conclusion: To diminish the risk of the operation, we have to obtain maximally the information of CS before procedures.