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      Implante de resincronizador cardiaco por vía femoral: Una alternativa para accesos subclavios difíciles Translated title: Cardiac resynchronization device implantation via the femoral artery: An alternative to difficult subclavian access

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          Abstract

          Pese a que no hay duda del beneficio de la terapia de resincronización cardiaca, el incremento del uso de esta técnica deja entrever dificultades en el posicionamiento de los electrodos y en particular del electrodo izquierdo. Se describe el caso de un hombre con indicación de terapia de resincronización cardiaca en quien, por anormalidades anatómicas de los vasos venosos izquierdos y por contraindicación para el uso de la región subclavia derecha, se utilizó la vía femoral derecha con éxito, hecho que permite mostrarla como una alternativa práctica y segura para el implante de resincronizadores cardiacos.

          Translated abstract

          Although there is no doubt of the benefit of cardiac resynchronization therapy, the increased use of this technique allows to see the difficulties in the positioning of electrodes, particularly of the left electrode. We describe the case of a man with an indication of cardiac resynchronization therapy in whom due to anatomical abnormalities of the left venous vessels and contraindication for the use of the right subclavian region, the right femoral route was successfully used. This allows us to show the femoral route as a practical and safe alternative for the implantation of cardiac resynchronization devices.

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          Most cited references5

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          Rationale and design of a randomized clinical trial to assess the safety and efficacy of cardiac resynchronization therapy in patients with advanced heart failure: the Multicenter InSync Randomized Clinical Evaluation (MIRACLE).

          Up to 50% of patients with chronic systolic heart failure have interventricular conduction delays, such as left bundle branch block, that result in abnormal electrical depolarization of the heart. Prolonged QRS duration results in abnormal interventricular septal wall motion, decreased contractility, reduced diastolic filling time, and prolonged duration of mitral regurgitation, which places the failing heart at a significant mechanical disadvantage. Prolonged QRS duration has been associated with poor outcome in heart failure patients. Atrial-synchronized, biventricular pacing or cardiac resynchronization therapy optimizes atrial-ventricular delay, narrows QRS duration, and seems promising in the management of advanced heart failure patients. Initial studies show improved quality of life and functional capacity compared with baseline or with no pacing. These studies, however, were either uncontrolled or poorly controlled, unblinded or only single-blinded, and enrolled small numbers of patients. The Multicenter InSync Randomized Clinical Evaluation (MIRACLE) is a large, prospective, randomized, double-blind, controlled trial designed to more definitively evaluate the clinical efficacy and safety of cardiac resynchronization for heart failure. The study is being completed in 3 phases (an initial pilot phase, a pivotal phase, and an expansion phase), enrolling 500 patients with New York Heart Association (NYHA) class III and IV systolic heart failure and QRS durations of 130 ms or more. Prospectively defined primary end points for the pivotal phase include evaluation of safety (implant success rate, freedom from stimulator- and ventricular-lead-related complications) and effects on functional status (quality of life, NYHA class, 6-minute hall walk distance) at 6 months. A variety of secondary end points will further define the efficacy and mechanism(s) of action of cardiac resynchronization in heart failure. The pivotal phase of MIRACLE will conclude in January 2001.
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            Permanent pacemaker implantation using the femoral vein: a preliminary report.

            A permanent pacemaker was implanted through the femoral vein in 23 patients using the percutaneous puncture technique. The pulse generator was placed in the lower abdominal wall. The method is simple and reduces the time necessary to accomplish implantation. Catheter extrusion in one patient was easily corrected. Another patient had late thrombophlebitis, possibly unrelated to the procedure. Catheter dislodgement occurred in four (4) patients and penetration of the right atrial appendage and right ventricular apex each occurred once. We believe these problems can be circumvented with more experience and expect the femoral approach to be a simple and practical method permanent pacemaker implantation.
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              Cardiac resynchronization via the femoral vein: a novel method in cases with contraindications to the pectoral approach.

              We describe a case involving biventricular pacemaker implantation via the right femoral vein in a patient where subclavian vein access was not possible.
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                Author and article information

                Journal
                rcca
                Revista Colombiana de Cardiología
                Rev. Colomb. Cardiol.
                Sociedad Colombiana de Cardiologia. Oficina de Publicaciones (Bogota, Cundinamarca, Colombia )
                0120-5633
                April 2012
                : 19
                : 2
                : 91-95
                Affiliations
                [01] Bogotá orgnameHospital Universitario de la Samaritana Colombia
                Article
                S0120-56332012000200007 S0120-5633(12)01900207
                430e1896-5301-4558-8cba-acc9b858fd57

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                : 19 April 2012
                : 19 January 2012
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 5, Pages: 5
                Product

                SciELO Colombia

                Self URI: Texto completo solamente en formato PDF (ES)
                Categories
                Presentación de casos - Cardiologia del adulto

                coronary sinus,femoral,cardiac resynchronization,seno coronario,acceso femoral,resincronizador cardiaco

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