The Jurdham Procedure for Endocardial Cardiac Resynchronization Therapy. Surgical Results and Short Term Follow-Up in 50 Patients

Aims: Endocardial left ventricular (LV) pacing presents unique advantages over traditional epicardial veins though the coronary sinus (CS) lead implantation for cardiac resynchronization therapy (CRT). However, more data regarding surgical results and short term clinical results and potential complications are needed. Several groups have published their clinical results and have demonstrated a low incidence of surgical and short term follow up complications in anticoagulated patients (pts). We present our acute and 1 month (m) follow up (FU) of 50 pts who underwent the Jurdham procedure for LV endocardial CRT, since August 2009 to September 2015 in different countries of Latin America.

Methods and Results: The Jurdham procedure was performed for LV endocardial CRT in pts able to take optimal vitamin K antagonist therapy (INR of 2-3) or Novel Oral Anticoagulants (NOACs) and with an accepted indication for CRT. In our early experience, this procedure was performed only in pts with a previous failed CRT implant, unsuitable coronary sinus anatomy or sub-optimal response. As from January 2014, we offered this procedure as a first option to previously anticoagulated pts undergoing their initial device implant. Fifty pts were implanted. Their demographics were: age 63.5 ± 9.42 y.o; 37 males, LVEF 23.64 ± 5.8%, QRS 172.63 ± 26.29 ms, NYHA Class 2.98 ± 0.58. The implant was successful in all pts in which was attempted. LV leads were implanted in the lateral or posterolateral medial LV region in all patients. In 9 pts it was an upgrade procedure, in 6, it was a right sided implant (in 2 due to left sided venous problems and in 4, due to right sided upgrades). In all cases active fixation endocardial silicon leads were used (Medtronic CapSureFix Novus 5076 / St. Jude Medical Tendril 1688T). No surgical, infectious, thromboembolic or hemorrhagic complications occurred during the FU period. 36 pts were anticoagulated with vitamin K antagonist drugs and 14 with NOACs. Acute LV threshold was 0.61 ± 0.23 V and 0.70 ± 0.27V after 1 m. NYHA Class at 1 m was 1.29 ± 0.46. There were no deaths.

Conclusions: In our experience, endocardial CRT using the Jurdham procedure was effective and safe, with satisfactory surgical and clinical results at short-term FU and no significant thrombo-embolic complications when patients are adequately anticoagulated. Larger studies are required to confirm these results and demonstrate the benefits of endocardial CRT.