Renal insufficiency (RI) is frequent in patients eligible for cardiac resynchronization therapy (CRT) and may be worsened by the use of contrast agents.

We sought to determine the feasibility of CRT implantation without contrast injection in patients with contraindication to iodine.

Patients eligible for CRT and presenting with RI were prospectively included (non-contrast NC group). A contemporary control group (CG) of CRT patients with contrast injection was used for comparison. An over-the-wire coronary sinus (CS) lead with angled distal tip was selected for this “blind harpooning” technique. A lateral branch was targeted at first intention in a left anterior oblique fluoroscopic view. In case of failure, a contrast injection was then allowed if no lateral branch was found with the « blind » strategy.

9 patients in the NC group were included (78±8 y). Serum creatinine was 204±72[imol/L (clearance 34.2±17ml/min). CG included 10 patients (69,8±7 y, serum creatinine 98.7±23[imol/L). CRT implantation was successful in 8/9 patients (88.9%) without contrast injection. Patient 9 was finally implanted with CS opacification after failure of the NC technique. Mean procedure time and fluoroscopy time were similar in the two groups:146±26 in the NC group versus 157±25 min (p = 0.34) and 24.8±15 in the NC group versus 24.5±20 min (p = 0.96) respectively. Mean CS lead implantation time was 45±21 (NC group) versus 37±12 min (p = 0.24). No major procedure-related complications were observed in both groups.

CRT implantation is feasible in the majority of the cases (88.9%) without contrast injection and without lengthening procedure time in patients with RI.