エジマ コウイチロウ   EJIMA KOICHIRO
  江島 浩一郎
   所属   医学部 医学科(東京女子医科大学病院)
   職種   特任准教授
言語種別 英語
発表タイトル Successful Coronary Vein Lead Implantation by Intravascular Ultrasound Guidance in a Patient with Life-Threatening Contrast Medium Anaphyraxis
会議名 12th Asia Pacific Heart Rhythm Society (APHRS) Scientific Sessions
主催者 Asia Pacific Heart Rhythm Society (APHRS)
学会区分 国際学会及び海外の学会
発表形式 口頭
講演区分 一般
発表者・共同発表者◎KATAOKA Shohei, YAGISHITA Daigo, KANAI Miwa, YAZAKI Kyoichiro, HIGUCHI Satoshi, EJIMA Koichiro, SHODA Morio, HAGIWARA Nobuhisa
発表年月日 2019/10/24
開催地
(都市, 国名)
Bangkok, THAILAND
概要 Introduction : A 51 years old male with dilated phase of hypertrophic cardiomyopathy was referred for severe heart failure management. Cardiac resynchronization therapy (CRT) was indicated due to 132ms of QRS duration, 25% of left ventricular ejection fraction and NYHA class Ⅲ heart failure symptom. However, the patient had a past history of life-threatening contrast medium anaphylaxis with urticarial rash and erosion on skin and oral mucous during contrast-enhanced computed tomography. Therefore, the use of contrast agent was considered as contraindication, and then, we planned a coronary vein (CV) lead implantation under the guidance of intravascular ultrasound (IVUS), described as follows.

Methods : (1) A guiding catheter cannulation into the main CV was performed by intracardiac electrogram guidance with a 6Fr decapolar electrode catheter (Inquiry, Abbott, IL, USA). (2) A 0.014-inch guide wire was advanced into the anterior intervenetricular vein, and an IVUS catheter (EAGLE EYE, Volcano, San Diego, CA, USA) was deployed over the wire. The IVUS imaging revealed an antero-lateral CV branch (AL), and the location of the bifurcation was also confirmed on the fluoroscopic image. (3) The guide wire was successfully advanced into the AL branch, and reached to the main CV via a postero-lateral branch (PL). Although two CV branches (AL and PL) were confirmed, AL seemed too small for CV lead placement. (4) After the guide wire advancement into the PL, the IVUS revealed approximately 34.5 mm length and 2.0-3.8 mm diameter of the PL (Figure). (5) A decapolar electrode catheter was placed using inner catheter into the PL, and acceptable pacing threshold without phrenic nerve stimulation was obtained within the PL. The intracardiac electrogram revealed reasonable electrical activation latency with 106 ms of Q-LV interval. (6) Finally, a quadripolar CV lead (4674, AcuityX4 spiral S, Boston, Minneapolis, MN, USA) was successfully placed at the latest activation site.

Result : Two months after the successful CRT implantation, echocardiography showed a decreased left ventricular end-systolic volume greater than 15%, as a definition of mechanical CRT responder.

Conclusion : A CV lead implantation by IVUS guidance can be a useful solution for patients with contrast medium anaphylaxis.