Multicenter prospective observational long-term follow-up study of endocardial cardiac resynchronization therapy using the Jurdham procedure


      Endocardial cardiac resynchronization therapy (eCRT) avoids the limitations and failures of coronary sinus (CS) resynchronization. However, data regarding long-term outcomes are lacking.


      The purpose of this study was to report the long-term outcome of eCRT performed using the Jurdham procedure in a real-world setting.


      eCRT was performed in patients who failed a CS implant or failed to respond to cardiac resynchronization therapy (CRT), or in selected patients requiring lifelong oral anticoagulation (OAC). Left ventricular ejection fraction (LVEF), New York Heart Association functional class (NYHA FC), and left ventricular stimulation parameters were assessed during long-term follow-up (FU).


      From August 2009 to March 2018, the Jurdham procedure was performed in 88 patients at 15 centers in 8 countries, with FU of 32.88 ± 61.52 months (range 0–88 months; 196 patient-years). NYHA FC improved from 2.9 preimplant to 1.3 during FU. LVEF increased <10 percentage points from baseline in 7% of patients, between 10 and 20 percentage points in 11% of patients, and >20 percentage points in 82% of patients. All-cause mortality at 60 months was 30.5%. Three transient ischemic attacks (1.53 per 100 patient-years) and 6 strokes (3.06 per 100 patient-years) occurred. Of the 6 patients with stroke, 4 (66%) had almost complete recovery.


      eCRT using the Jurdham procedure is an effective and safe technique in anticoagulated patients. This approach may be an attractive option for patients with failed CS implants or nonresponders to CS CRT. In addition, it might be a reasonable approach as a first option for treatment of patients requiring lifelong OAC.


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        • Sohaib S.M.
        • Chen Z.
        • Whinnett Z.I.
        • et al.
        Meta-analysis of symptomatic response attributable to the pacing component of cardiac resynchronization therapy.
        Eur J Heart Fail. 2013; 15: 1419-1428
        • Birnie D.H.
        • Tang A.S.
        The problem of non-response to cardiac therapy.
        Curr Opin Cardiol. 2006; 21: 20-26
        • Morgan J.M.
        • Biffi M.
        • Gellér L.
        • et al.
        • on behalf of the ALSYNC Investigators
        ALternate Site Cardiac ResYNChronization (ALSYNC): a prospective and multicentre study of left ventricular endocardial pacing for cardiac resynchronization therapy.
        Eur Heart J. 2016; 37: 2118-2127
        • Negrete A.
        • Molina L.
        • Torres R.
        • et al.
        The Jurdham procedure for endocardial cardiac resynchronization therapy: surgical results and short term follow-up in 50 patients (abstract). International Dead Sea Symposium, Tel Aviv, Israel.
        • Elencwajg B.
        • López Cabanillas N.
        • Cardinali E.L.
        The Jurdham procedure: endocardial left ventricular lead insertion via a femoral transseptal sheath for cardiac resynchronization therapy pectoral device implantation.
        Heart Rhythm. 2012; 9: 1798-1804
        • Vahanian A.
        • Alfieri O.
        • Andreotti F.
        • et al.
        Guidelines on the management of valvular heart disease (version 2012).
        Eur Heart J. 2012; 33: 2451-2496
        • Rankin J.
        Cerebral vascular accidents in patients over the age of 60.
        Scott Med J. 1957; 2: 200-215
        • Özcan E.E.
        • Szilagyi S.
        • Sallo Z.
        • et al.
        Comparison of the effects of epicardial and endocardial cardiac resynchronization therapy on transmural dispersion of repolarization.
        Pacing Clin Electrophysiol. 2015; 38: 1099-1105
        • Gamble J.H.P.
        • Herring N.
        • Ginks M.
        • Rajappan K.
        • Bashir Y.
        • Betts T.R.
        Endocardial left ventricular pacing for cardiac resynchronization: systematic review and meta-analysis.
        Europace. 2018; 20: 73-81
        • Rademakers L.M.
        • vanGelder B.M.
        • Scheffer M.G.
        • Bracke F.A.
        Mid-term follow up of thromboembolic complications in left ventricular endocardial cardiac resynchronization therapy.
        Heart Rhythm. 2014; 11: 609-613
        • Easton J.D.
        • Saver J.L.
        • Albers G.W.
        • et al.
        Definition and evaluation of transient ischemic attack: a scientific statement for healthcare professionals from the American Heart Association/American Stroke Association Stroke Council; Council on Cardiovascular Surgery and Anesthesia; Council on Cardiovascular Radiology and Intervention; Council on Cardiovascular Nursing; and the Interdisciplinary Council on Peripheral Vascular Disease.
        Stroke. 2009; 40: 2276-2293
        • Bonita R.
        • Beaglehole R.
        Modification of Rankin scale: recovery of motor function after stroke.
        Stroke. 1988; 19: 1497-1500
        • Jaïs P.
        • Takahashi A.
        • Garrigue S.
        • et al.
        Mid-term follow-up of endocardial biventricular pacing.
        Pacing Clin Electrophysiol. 2000; 23: 1744-1747
        • Pasquié J.L.
        • Massin F.
        • Macia J.C.
        • et al.
        Long-term follow-up of biventricular pacing using a totally endocardial approach in patients with end-stage cardiac failure.
        Pacing Clin Electrophysiol. 2007; 30: S31-S33
        • Bruce C.J.
        • Friedman P.A.
        • Narayan O.
        • et al.
        Early heparinization decreases the incidence of left atrial thrombi detected by intracardiac echocardiography during radiofrequency ablation for atrial fibrillation.
        J Interv Card Electrophysiol. 2008; 22: 211-219
        • Sugrue A.
        • DeSimone C.V.
        • Lenz C.J.
        • Packer D.L.
        • Asirvatham S.J.
        Mobile thrombus on cardiac implantable electronic device leads of patients undergoing cardiac ablation: incidence, management and outcomes.
        J Interv Card Electrophysiol. 2016; 46: 115-120
        • Rickard J.
        • Cheng A.
        • Spragg D.
        • et al.
        Durability of the survival effect of cardiac resynchronization therapy by level of left ventricular functional improvement: fate of “non-responders”.
        Heart Rhythm. 2014; 11: 412-416
        • Loh E.
        • St. John Sutton M.
        • Wun C.C.
        • et al.
        Ventricular dysfunction and the risk of stroke after myocardial infarction.
        N Engl J Med. 1997; 336: 251-257
        • Pfeffer M.A.
        • Braunwald E.
        • Moyé L.A.
        • et al.
        Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction—results of the Survival and Ventricular Enlargement Trial.
        N Engl J Med. 1992; 327: 669-677