1
|
Ballantyne BA, Chew DS, Vandenberk B. Paradigm Shifts in Cardiac Pacing: Where Have We Been and What Lies Ahead? J Clin Med 2023; 12:jcm12082938. [PMID: 37109274 PMCID: PMC10146747 DOI: 10.3390/jcm12082938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
The history of cardiac pacing dates back to the 1930s with externalized pacing and has evolved to incorporate transvenous, multi-lead, or even leadless devices. Annual implantation rates of cardiac implantable electronic devices have increased since the introduction of the implantable system, likely related to expanding indications, and increasing global life expectancy and aging demographics. Here, we summarize the relevant literature on cardiac pacing to demonstrate the enormous impact it has had within the field of cardiology. Further, we look forward to the future of cardiac pacing, including conduction system pacing and leadless pacing strategies.
Collapse
Affiliation(s)
- Brennan A Ballantyne
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Derek S Chew
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven, 3000 Leuven, Belgium
- Department of Cardiology, University Hospitals Leuven, 3000 Leuven, Belgium
| |
Collapse
|
2
|
Hayashi K, Younis A, Callahan T, Baranowski B, Martin DO, Nakhla S, Wilkoff BL. Clinical Predictors of Incomplete CS Lead Removal during Transvenous Lead Extraction in the Patients with Cardiac Resynchronization Therapy. Heart Rhythm 2023; 20:872-878. [PMID: 36933853 DOI: 10.1016/j.hrthm.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/24/2023] [Accepted: 03/13/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND Reports of coronary sinus (CS) lead removal include small studies with short implant durations. Procedural outcomes for mature CS leads removed with long duration implantation are unavailable. OBJECTIVE To examine the safety, efficacy, and clinical predictors for incomplete CS lead removal by Transvenous Lead Extraction (TLE) in a large, long implant duration cardiac resynchronization therapy (CRT) patient cohort. METHODS Consecutive patients with CRT devices in the Cleveland Clinic Prospective TLE Registry who had TLE between 2013 and 2022. RESULTS CS leads, n=231, implant duration = 6.1±4.0 years, removed from 226 patients were included, employing powered sheaths for 137 leads (59.3%). Complete CS lead success was achieved in 95.2% of leads (n=220) and in 95.6% of patients (n=216). Major complications occurred in 5 patients (2.2%). Patients who had the CS lead extracted 1st had significantly higher incomplete removal rates than when the other leads were 1st removed. Multivariable analysis showed that older CS lead age (OR 1.35, 95% CI 1.01-1.82; P = 0.03), and removing the CS lead 1st (OR 7.48, 95% CI 1.02-54.95; P = 0.045) were independent predictors of incomplete CS lead removal. CONCLUSION Complete and safe lead removal rate of long implant duration CS leads by TLE was 95%. However, CS lead age and the order that leads were extracted were the independent predictors of incomplete CS lead removal. Therefore, before the CS lead is extracted, physicians should first extract the leads from the other chambers and employ powered sheaths.
Collapse
Affiliation(s)
- Katsuhide Hayashi
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Arwa Younis
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Thomas Callahan
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Bryan Baranowski
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - David O Martin
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Shady Nakhla
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States
| | - Bruce L Wilkoff
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, United States.
| |
Collapse
|
3
|
Inamura Y, Inaba O, Sato A, Nitta J, Goya M, Sasano T. Novel lead anchor technique using an active fixation quadripolar left ventricular lead in cardiac resynchronization therapy. Clin Case Rep 2022; 10:e05332. [PMID: 35140949 PMCID: PMC8810947 DOI: 10.1002/ccr3.5332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 11/13/2022] Open
Abstract
In this report, we present a case of successful advancement of a LV lead into tortuous vessels. This was achieved by deep engagement of the coronary sinus with a cannulation catheter by applying the anchor technique using the Medtronic Attain Stability Quad lead.
Collapse
Affiliation(s)
- Yukihiro Inamura
- Department of Cardiology Japanese Red Cross Saitama Hospital Saitama Japan
| | - Osamu Inaba
- Department of Cardiology Japanese Red Cross Saitama Hospital Saitama Japan
| | - Akira Sato
- Department of Cardiology Japanese Red Cross Saitama Hospital Saitama Japan
| | - Junichi Nitta
- Department of Cardiology Sakakibara Heart Institute Tokyo Japan
| | - Masahiko Goya
- Department of Cardiology Tokyo Medical and Dental University Tokyo Japan
| | - Tetsuo Sasano
- Department of Cardiology Tokyo Medical and Dental University Tokyo Japan
| |
Collapse
|
4
|
Gerontitis D, Diab I, Chow AWC, Hunter RJ, Leyva F, Turley AJ, Williams I, Ullah W. UK multicenter retrospective comparison of novel active versus conventional passive fixation coronary sinus leads. J Cardiovasc Electrophysiol 2020; 31:2948-2953. [PMID: 32716096 DOI: 10.1111/jce.14694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/11/2020] [Accepted: 07/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND A novel active fixation coronary sinus (CS) lead, Attain Stability (AS), has been released aiming to improve targeted lead positioning. Rather than being wedged into the distal vessel, it relies on a side helix for fixation. We aimed to compare implant procedure parameters and electromechanical stability of the AS lead with passive CS leads. METHODS A retrospective study involving six major UK cardiac centers. Patients who received active fixation leads were compared with passive fixation lead recipients in a 1:2 ratio. The primary outcome was total lead displacements (combined macrodisplacement/microdisplacement, defined as displacements requiring repositioning procedures, an increase in threshold ≥0.5 V or pulse width ≥0.5 ms, or a change in pacing polarity). RESULTS A total of 761 patients were included (253 AS leads and 508 passive fixation leads), of which 736 had follow-up data. The primary endpoint rate was 31% (75/241) in the active and 43% (214/495) in the passive group (p = .002). Six patients (2.5%) in the active group and 14 patients (2.8%) in the passive group required CS lead repositioning procedures (p = 0.981). On multivariable analysis, active leads were associated with a reduction in lead displacements, odds ratio 0.66 (95% confidence interval: 0.46-0.95), p = .024. There were differences in favor of passive leads in procedure duration, 120 (96-149) versus 127 (105-155) min (p = .008), and fluoroscopy time, 17 (11-26) versus 18.5 (13-27) min (p = .0022). The median follow-up duration was similar (active vs. passive): 31 (17-47) versus 34 (16-71) weeks, (p = .052). CONCLUSION AS CS leads had improved electromechanical stability compared with passive fixation leads, with only minimal increases in implant procedure and fluoroscopy times.
Collapse
Affiliation(s)
- Dimitrios Gerontitis
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ihab Diab
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Anthony W C Chow
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Ross J Hunter
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Francisco Leyva
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
| | - Andrew J Turley
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | - Ian Williams
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Waqas Ullah
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | | |
Collapse
|
5
|
Jackson KP, Faerestrand S, Philippon F, Yee R, Kong MH, Kloppe A, Bongiorni MG, Lee SF, Canby RC, Pouliot E, van Ginneken MME, Crossley GH. Performance of a novel active fixation quadripolar left ventricular lead for cardiac resynchronization therapy: Attain Stability Quad Clinical Study results. J Cardiovasc Electrophysiol 2020; 31:1147-1154. [PMID: 32162757 DOI: 10.1111/jce.14439] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Medtronic Attain Stability Quad lead is a quadripolar left ventricular (LV) lead with an active fixation helix assembly designed to fixate the lead within the coronary sinus and pace nonapical regions of the LV. The primary objective of this study was to determine the safety and effectiveness of this novel active fixation quadripolar LV lead. METHODS Patients with standard indications for cardiac resynchronization therapy (CRT) were enrolled. All patients were followed at 3 and 6 months post-implant and every 6 months thereafter until study closure. Pacing capture thresholds (PCTs) were measured at implant and each follow-up and adverse events (AEs) were recorded upon occurrence. RESULTS Of the 440 patients who underwent implant procedures, placement of the Attain Stability Quad lead was successful in 426 (96.8%). LV lead-related complications occurred in 10 patients (2.3%), including LV lead dislodgement in three patients (0.7%). The percentage of patients with at least one LV pacing vector with a PCT ≤2.5 V at a 6-month follow-up was 96.3%. The LV lead was successfully fixated to the prespecified pacing location in 97.4% of cases. CONCLUSIONS This large, multinational study of the Attain Stability Quad lead demonstrated a high rate of implant success with a low complication rate. The active fixation mechanism allowed precise placement of the pacing electrodes at the desired target region with good PCTs and a very low dislodgement rate.
Collapse
Affiliation(s)
- Kevin P Jackson
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Svein Faerestrand
- Department of Clinical Science, University of Bergen and Haukeland University Hospital, Bergen, Norway
| | - Francois Philippon
- Department of Medicine, Institut Universitaire De Cardiologie Et De Pneumologie De Quebec, Quebec, Canada
| | - Raymond Yee
- Division of Cardiology, University Hospital, London, Ontario, Canada
| | | | - Axel Kloppe
- Medizinische Klinik II, BG Universitätsklinikum Bergmannsheil, Bochum, Germany
| | | | - Scott F Lee
- Baptist Heart Specialists, Ponte Vedra Beach, Florida
| | | | | | | | - George H Crossley
- Division of Cardiology, Vanderbilt University Heart and Vascular Institute, Nashville, Tennessee
| |
Collapse
|
6
|
Crevelari ES, Silva KRD, Albertini CMDM, Vieira MLC, Martinelli Filho M, Costa R. Efficacy, Safety, and Performance of Isolated Left vs. Right Ventricular Pacing in Patients with Bradyarrhythmias: A Randomized Controlled Trial. Arq Bras Cardiol 2019; 112:410-421. [PMID: 30994720 PMCID: PMC6459436 DOI: 10.5935/abc.20180275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 09/05/2018] [Indexed: 11/22/2022] Open
Abstract
Background Considering the potential deleterious effects of right ventricular (RV)
pacing, the hypothesis of this study is that isolated left ventricular (LV)
pacing through the coronary sinus is safe and may provide better clinical
and echocardiographic benefits to patients with bradyarrhythmias and normal
ventricular function requiring heart rate correction alone. Objective To assess the safety, efficacy, and effects of LV pacing using an
active-fixation coronary sinus lead in comparison with RV pacing, in
patients eligible for conventional pacemaker (PM) implantation. Methods Randomized, controlled, and single-blinded clinical trial in adult patients
submitted to PM implantation due to bradyarrhythmias and systolic
ventricular function ≥ 0.40. Randomization (RV vs. LV) occurred
before PM implantation. The main results of the study were procedural
success, safety, and efficacy. Secondary results were clinical and
echocardiographic changes. Chi-squared test, Fisher's exact test and
Student's t-test were used, considering a significance level of 5%. Results From June 2012 to January 2014, 91 patients were included, 36 in the RV
Group and 55 in the LV Group. Baseline characteristics of patients in both
groups were similar. PM implantation was performed successfully and without
any complications in all patients in the RV group. Of the 55 patients
initially allocated into the LV group, active-fixation coronary sinus lead
implantation was not possible in 20 (36.4%) patients. The most frequent
complication was phrenic nerve stimulation, detected in 9 (25.7%) patients
in the LV group. During the follow-up period, there were no hospitalizations
due to heart failure. Reductions of more than 10% in left ventricular
ejection fraction were observed in 23.5% of patients in the RV group and
20.6% of those in the LV group (p = 0.767). Tissue Doppler analysis showed
that 91.2% of subjects in the RV group and 68.8% of those in the LV group
had interventricular dyssynchrony (p = 0.022). Conclusion The procedural success rate of LV implant was low, and the safety of the
procedure was influenced mainly by the high rate of phrenic nerve
stimulation in the postoperative period.
Collapse
Affiliation(s)
- Elizabeth Sartori Crevelari
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Katia Regina da Silva
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Caio Marcos de Moraes Albertini
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Martino Martinelli Filho
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| | - Roberto Costa
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, SP - Brazil
| |
Collapse
|
7
|
Das A, Chatterjee S. Feasibility of RA-LV pacing in patients with symptomatic left bundle branch block: a pilot study. Heart Vessels 2019; 34:1552-1558. [PMID: 30963301 DOI: 10.1007/s00380-019-01390-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 03/22/2019] [Indexed: 11/29/2022]
Abstract
Several studies have reported the adverse effects of right ventricular apical pacing. Permanent His bundle pacing is proved to be the most physiological. But it can be technically difficult sometimes. One recent large multicenter randomized trial showed that pacing from left ventricular apex or mid-lateral wall has the greatest potential to prevent pacing-induced reduction of cardiac pump function (by maintaining left ventricular mechanical synchrony) and, therefore, can be considered as physiological site. In our study, we have wanted to see the outcome of left ventricular pacing through coronary sinus branch with active fixation bipolar lead as a routine pacing technique in patients with symptomatic left bundle branch block. In our study we have recruited 27 patients for left ventricular pacing through coronary sinus branch (as done in cardiac resynchronization therapy) with active fixation bipolar lead and 33 patients for right ventricular apical pacing (control) and compared left ventricular pacing with right ventricular apical pacing in patients with history of syncope with left bundle branch block in baseline electrocardiography who presented with atrio-ventricular block or prolonged HV interval (≥ 70 ms) on electrophysiology study in term of procedure and fluoroscopy time and short-term lead performance and left ventricular function. The results of our study showed that left ventricular pacing through a tributary of coronary sinus is associated with shortened QRS duration (21.10 ± 3.92 ms) and better LV function (higher left ventricular ejection fraction 64.00 ± 3.03 vs. 59.73 ± 6.73 and lower left ventricular diastolic internal diameter 4.58 ± 0.32 vs. 5.23 ± 0.40 cm) in comparison to right ventricular apical pacing. However, the total procedure time and fluoroscopy time was significantly higher (73.75 ± 11.02 vs. 63.32 ± 6.06 min and 7.08 ± 1.48 vs. 5.02 ± 1.39 min, respectively) in left ventricular pacing group. The results of this study indicate that transvenous left ventricular epicardial pacing may be an option for physiological pacing in patients with symptomatic left bundle branch block.
Collapse
Affiliation(s)
- Asit Das
- Department of Cardiology, IPGME&R and SSKM Hospital, Flat-B1, GB-43, Narayantala (west), DB Nagar, Kolkata, West Bengal, 700059, India.
| | - Suman Chatterjee
- Department of Cardiology, IPGME&R and SSKM Hospital, Flat-B1, GB-43, Narayantala (west), DB Nagar, Kolkata, West Bengal, 700059, India
| |
Collapse
|
8
|
Mela T. Explanting Chronic Coronary Sinus Leads. Card Electrophysiol Clin 2019; 11:131-140. [PMID: 30717845 DOI: 10.1016/j.ccep.2018.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiac resynchronization therapy (CRT) has become the gold standard for patients with systolic left ventricular function, left ventricular ejection fraction less than or equal to 35%, wide complex QRS, and symptomatic heart failure. Annual implantation volume has steadily increased because of expanding indications for CRT. Improved survival resulted in many of these patients having their CRT devices for many years and eventually requiring an increased number of device-related procedures, including coronary sinus lead revisions and replacements following a coronary sinus lead extraction.
Collapse
Affiliation(s)
- Theofanie Mela
- Cardiac Arrhythmia Service, Massachusetts General Hospital, 75 Fruit Street, Boston, MA 02114, USA.
| |
Collapse
|
9
|
Baggio JM, Afiune CMC, Afiune JY, Sarabanda AV, Atik FA. Transvenous dual-chamber pacemaker after paediatric heart transplantation using left ventricle pacing through the coronary sinus. ESC Heart Fail 2018; 5:204-207. [PMID: 29356392 PMCID: PMC5793968 DOI: 10.1002/ehf2.12254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 10/28/2017] [Accepted: 11/27/2017] [Indexed: 11/11/2022] Open
Abstract
A 12‐year‐old child with end‐stage heart failure due to restrictive cardiomyopathy was submitted to orthotopic heart transplantation. Primary graft dysfunction required venous arterial extra‐corporeal membrane oxygenation. Heart function normalized, but complete atrioventricular block remained after 3 weeks. A dual‐chamber pacing with transvenous left ventricle pacing through the coronary sinus was performed. At 5‐year follow‐up, the patient is stable with the same pacing system and with preserved ventricular function.
Collapse
Affiliation(s)
- José Mario Baggio
- Division of Electrophysiology and Cardiac Device Unit, Instituto de Cardiologia do Distrito Federal, Brasília, Brazil
| | | | - Jorge Y Afiune
- Division of Pediatric Cardiology, Instituto de Cardiologia do Distrito Federal, Brasília, Brazil
| | - Alvaro V Sarabanda
- Division of Electrophysiology and Cardiac Device Unit, Instituto de Cardiologia do Distrito Federal, Brasília, Brazil
| | - Fernando A Atik
- Division of Cardiovascular Surgery and Transplant Unit, Instituto de Cardiologia do Distrito Federal, St Sudoeste Cruzeiro Novo, Brasília, 70658-700, Brazil
| |
Collapse
|
10
|
Cronin EM. Coronary Venous Lead Extraction. J Innov Card Rhythm Manag 2017; 8:2758-2764. [PMID: 32494456 PMCID: PMC7252920 DOI: 10.19102/icrm.2017.080604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 04/18/2017] [Indexed: 11/06/2022] Open
Abstract
The increasing number of cardiac resynchronization therapy devices implanted, coupled with the increasing incidence of cardiac implantable electronic device infection, has led to a greater need for extraction of coronary venous pacing leads. The objectives of this study were to review the indications, techniques and published results of coronary venous lead extraction. In this study, we searched PubMed using the search terms "lead extraction," "coronary sinus," "coronary venous," "pacing," and "cardiac resynchronization therapy" for relevant papers. The reference lists of relevant articles were also searched, and personal experience was drawn upon. Published success rates and complications were found to be similar to those reported for non-coronary venous leads in experienced centers. However, reimplantation success differs and can be limited by vessel occlusion postextraction. The available active fixation coronary sinus lead (Attain Starfix™; Medtronic, MN, USA) is a particularly complex lead to extract, whereas limited data on the newer active fixation leads (Attain Stability™, Medtronic, MN, USA) suggest that they are less challenging to remove. The study concluded that coronary venous lead extraction presents unique challenges, especially reimplantation, that require special consideration and planning to overcome.
Collapse
Affiliation(s)
- Edmond M Cronin
- Hartford HealthCare Heart and Vascular Institute at Hartford Hospital, Hartford, CT.,University of Connecticut School of Medicine, Farmington, CT
| |
Collapse
|
11
|
Crossley GH, Sorrentino RA, Exner DV, Merliss AD, Tobias SM, Martin DO, Augostini R, Piccini JP, Schaerf R, Li S, Miller CT, Adler SW. Extraction of chronically implanted coronary sinus leads active fixation vs passive fixation leads. Heart Rhythm 2016; 13:1253-9. [DOI: 10.1016/j.hrthm.2016.01.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Indexed: 11/30/2022]
|
12
|
Golzio PG, Meynet I, Orzan F, Pellissero E, Castagno D, Ferraris F, Gaita F. Starfix lead extraction: Clinical experience and technical issues. J Cardiol Cases 2016; 13:25-30. [PMID: 30546604 PMCID: PMC6281896 DOI: 10.1016/j.jccase.2015.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 11/29/2022] Open
Abstract
Transvenous lead extraction (TLE) of the Starfix coronary sinus (CS) active-fixation lead may be challenging, due to undeployment of fixation lobes and venous occlusion. We report our experience in Starfix TLE, in comparison with previous data. A 78-year-old male, implanted in 2009 with Starfix lead, was referred to our institution for TLE, due to infective endocarditis with lead-associated vegetations. The tip of Starfix lead was located in distant, anterior position, in the great cardiac vein, close to patent left internal mammary artery-to-left anterior descending artery anastomosis, and first-choice surgical removal had a prohibitive operative risk. Conventional dilatation beyond CS ostium, as well as the use of a standard delivery catheter, was ineffective. An off-label modification of the delivery, by cutting the distal soft tip, was successful. However, the tip of the lead fragmented and was trapped in the innominate vein. Then a gooseneck snare grasped the fragment, allowing complete retrieval. TLE of Starfix leads may be particularly challenging, especially when its tip is located in a distant anterior location. In these cases, important help may be obtained by dilatation within the CS, by means of conventional or modified delivery catheters. Only experienced operators, sometimes with non-conventional techniques, should perform TLE of Starfix leads. .
Collapse
Affiliation(s)
- Pier Giorgio Golzio
- Division of Cardiology, Department of Internal Medicine, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | | | | | | | | | | | | |
Collapse
|
13
|
Crossley GH, Biffi M, Johnson B, Lin A, Gras D, Hussin A, Cuffio A, Collier JL, El-Chami M, Li S, Holloman K, Exner DV. Performance of a novel left ventricular lead with short bipolar spacing for cardiac resynchronization therapy: Primary results of the Attain Performa Quadripolar Left Ventricular Lead Study. Heart Rhythm 2015; 12:751-8. [DOI: 10.1016/j.hrthm.2014.12.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Indexed: 10/24/2022]
|
14
|
Biffi M, Bertini M, Ziacchi M, Diemberger I, Martignani C, Boriani G. Left ventricular lead stabilization to retain cardiac resynchronization therapy at long term: when is it advisable? Europace 2013; 16:533-40. [DOI: 10.1093/europace/eut300] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
|
15
|
Ohlow MA, Lauer B, Brunelli M, Daralammouri Y, Geller C. The Use of a Quadripolar Left Ventricular Lead Increases Successful Implantation Rates in Patients with Phrenic Nerve Stimulation and/or High Pacing Thresholds Undergoing Cardiac Resynchronisation Therapy with Conventional Bipolar Leads. Indian Pacing Electrophysiol J 2013; 13:58-65. [PMID: 23573059 PMCID: PMC3594899 DOI: 10.1016/s0972-6292(16)30605-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Phrenic nerve stimulation (PNS) and high pacing thresholds (HPT) hinder biventricular stimulation in patients (pts) undergoing cardiac resynchronization therapy (CRT). A new quadripolar left ventricular (LV) lead (Quartet 1458Q, St. Jude Medical) with increased number of pacing configuration, might overcome this problem. Methods All consecutive pts in whom a standard bipolar lead intraoperatively resulted in PNS and/or HPT (≥4.00V/1mV), received, during the same implant, a quadripolar LV lead. Aim of the study was to evaluate acute and short term outcome. Results 26 pts [24 (92%) male, mean age 74±6 years)] with PNS (22 pts; 85%) and HPT (4 pts; 15%) were included. Permanent right ventricular pacing was the reason for broad QRS complex in 4 (15%) pts, whereas all other pts had a left bundle branch block. Severely symptomatic (NYHA Class ≥3) heart failure with reduced ejection fraction (EF 31±9%) was mostly caused by ischemic heart disease (14 pts; 54%). Idiopathic dilated cardiomyopathy and valvular heart disease were diagnosed in 6 (23%) pts each. In most (24/26, 92%) pts the use of the Quartet lead led to successful biventricular pacing due to a significant reduction in intraoperative pacing threshold (5.2V/1.0ms vs. 1.4V/0.8ms; p=0.03), which was maintained (1.2V/0.7ms) at follow-up. PNS never represented reason for failed LV pacing, neither acutely nor during follow-up. Conclusion Excessively HPT and/or PNS are frequently encountered when conventional bipolar leads are used for CRT. A new quadripolar LV lead increases the rate of successful biventricular stimulation. Lower pacing threshold and freedom from PNS are maintained at follow-up.
Collapse
Affiliation(s)
- Marc-Alexander Ohlow
- Department of Cardiology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany
| | | | | | | | | |
Collapse
|
16
|
Active fixation mechanism complicates coronary sinus lead extraction and limits subsequent reimplantation targets. J Interv Card Electrophysiol 2012; 36:81-6; discussion 86. [DOI: 10.1007/s10840-012-9704-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Accepted: 05/30/2012] [Indexed: 10/28/2022]
|
17
|
Biffi M, Exner DV, Crossley GH, Ramza B, Coutu B, Tomassoni G, Kranig W, Li S, Kristiansen N, Voss F. Occurrence of phrenic nerve stimulation in cardiac resynchronization therapy patients: the role of left ventricular lead type and placement site. Europace 2012; 15:77-82. [PMID: 22848075 DOI: 10.1093/europace/eus237] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
AIMS Unwanted phrenic nerve stimulation (PNS) has been reported in ∼1 in 4 patients undergoing left ventricular (LV) pacing. The occurrence of PNS over mid-term follow-up and the significance of PNS are less certain. METHODS AND RESULTS Data from 1307 patients enrolled in pre-market studies of LV leads manufactured by Medtronic (models 4193 and 4195 unipolar, 4194, 4196, 4296, and 4396 bipolar) were pooled. Left ventricular lead location was recorded at implant using a common classification scheme. Phrenic nerve stimulation symptoms were either spontaneously reported or identified at scheduled follow-up visits. A PNS-related complication was defined as PNS resulting in invasive intervention or the termination of LV pacing. Average follow-up was 14.9 months (range 0.0-46.6). Phrenic nerve stimulation symptoms occurred in 169 patients (12.9%). Phrenic nerve stimulation-related complications occurred in 21 of 1307 patients (1.6%); 16 of 738 (2.2%) in the unipolar lead studies, and 5 of 569 (0.9%) in the bipolar lead studies (P = 0.08). Phrenic nerve stimulation was more frequent at middle-lateral/posterior, and apical LV sites (139/1010) vs. basal-posterior/lateral/anterior, and middle-anterior sites (20/297; P= 0.01). As compared with an anterior LV lead position, a lateral LV pacing site was associated with over a four-fold higher risk of PNS (P= 0.005) and an apical LV pacing site was associated with over six-fold higher risk of PNS (P= 0.001). CONCLUSION Phrenic nerve stimulation occurred in 13% of patients undergoing LV lead placement and was more common at mid-lateral/posterior, and LV apical sites. Most cases (123/139; 88%) of PNS were mitigated via electrical reprogramming, without the need for invasive intervention.
Collapse
Affiliation(s)
- Mauro Biffi
- Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
KALAHASTY GAUTHAM, ELLENBOGEN KENNETHA. The Active Fixation Coronary Sinus Lead: More Peril than Promise? PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:639-40. [DOI: 10.1111/j.1540-8159.2012.03397.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
Maytin M, Carrillo RG, Baltodano P, Schaerf RHM, Bongiorni MG, Di Cori A, Curnis A, Cooper JM, Kennergren C, Epstein LM. Multicenter experience with transvenous lead extraction of active fixation coronary sinus leads. Pacing Clin Electrophysiol 2012; 35:641-7. [PMID: 22432739 DOI: 10.1111/j.1540-8159.2012.03353.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVE Active fixation coronary sinus (CS) leads limit dislodgement and represent an attractive option to the implanter. Although extraction of passive fixation CS leads is a common and frequently uncomplicated procedure, data regarding extraction of chronically implanted active fixation CS leads are limited. METHODS We performed a retrospective cohort study of patients undergoing active fixation CS lead extraction at six centers. Patient and procedural characteristics, indications for extraction, use of extraction sheath (ES) assistance, and outcomes are reported. RESULTS Between January 2009 and February 2011, 12 patients underwent transvenous lead extraction (TLE) of Medtronic StarFix® lead (Medtronic Inc., Minneapolis, MN, USA). The cohort was 83% male with mean age 71 ± 14 years. Average implant duration was 14.2 ± 5.7 months (2.3-23.6). All leads but one were removed for infectious indications (67% systemic infection). At the time of explant, the fixation lobes were completely retracted in only one of the 12 cases and ES assistance was required for lead removal in all cases (58% laser, 25% cutting, 25% mechanical, and 25% femoral). The majority of cases required advancement of the sheath into the CS (75.0%) and often into a branch vessel (41.7%). One lead could not be removed transvenously and required surgical lead extraction. There were no major complications. Examination of the leads after extraction frequently revealed significant tissue growth into the fixation lobes. CONCLUSIONS Although TLE of active fixation CS leads can be a safe procedure in select patients and experienced hands, powered sheaths and aggressive techniques are frequently required for successful removal despite relatively short implant durations. This raises significant concern regarding future TLE of active fixation CS leads with longer implant durations.
Collapse
Affiliation(s)
- Melanie Maytin
- Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Sheldon S, Friedman PA, Hayes DL, Osborn MJ, Cha YM, Rea RF, Asirvatham SJ. Outcomes and predictors of difficulty with coronary sinus lead removal. J Interv Card Electrophysiol 2012; 35:93-100. [PMID: 22584767 DOI: 10.1007/s10840-012-9685-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 04/02/2012] [Indexed: 01/31/2023]
Abstract
With increasing coronary sinus (CS) pacemaker leads for cardiac resynchronization therapy, the need to remove these leads has risen. The purpose of this study is to describe a single center's experience with CS lead removal and to attempt to identify predictors of difficulty with lead removal and complications. We reviewed all percutaneous endocardial CS lead removals performed at our institution through February 2010. Successful removal with traction alone was considered simple while complex extractions required traction devices and/or laser sheaths. Between December 1996 and February 2010, 125 CS leads were percutaneously removed ≥1 week post-implantation from 115 patients. One attempt at CS lead extraction was unsuccessful. The average duration since implantation for the CS leads was 1.54 years (± .75 years, range 8 days to 8.24 years). The majority of the leads were removed by simple traction (n = 114, 91.2 %). The remainder were removed by femoral approach with snare (n = 3, 2.4 %), locking stylet (n = 2, 1.6 %), or locking stylet and laser sheath (n = 6, 4.8 %). Half of CS leads in place greater than 4 years required complex extraction (n = 7/14, 50 %). CS complications (n = 11 patients, 8.8 %) included CS or tributary thrombosis (n = 7/102, 6.9 %) and CS dissection (n = 4/102, 3.9 %). Major non-CS complications (n = 2 patients, 1.6 %) included a cardiac tear requiring pericardiocentesis and thoracotomy (n = 1, 0.8 %) and subclavian vein tear requiring surgical repair (n = 1, 0.8 %). Minor non-CS complications (n = 9 patients, 7.2 %) included a pneumothorax (n = 1, 0.8 %), hematoma (n = 2, 1.6 %), subclavian vein thrombosis (n = 3, x%), and blood transfusion (n = 5, 4.0 %). A longer duration since implantation and larger lead diameter were associated with complex versus simple removal (p < .0001 and p = .0009 respectively). Percutaneous CS lead removal is successful by simple traction alone in the vast majority of cases. CS leads in place greater than 4 years, however, often require complex extraction. Specific extraction techniques can be implemented when simple traction is unsuccessful without an appreciable increase in complications.
Collapse
Affiliation(s)
- Seth Sheldon
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | | | | |
Collapse
|
21
|
Mediratta N, Barker D, McKevith J, Davies P, Belchambers S, Rao A. Thoracoscopic patch insulation to correct phrenic nerve stimulation secondary to cardiac resynchronization therapy. Europace 2011; 14:1049-53. [PMID: 22186779 DOI: 10.1093/europace/eur396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AIMS Cardiac resynchronization therapy is an established therapy for heart failure, improving quality of life and prognosis. Despite advances in technique, available leads and delivery systems, trans-venous left ventricular (LV) lead positioning remains dependent on the patient's underlying venous anatomy. The left phrenic nerve courses over the surface of the pericardium laterally and may be stimulated by the LV pacing lead, causing uncomfortable diaphragmatic twitch. This paper describes a video-assisted thoracoscopic (VATS) procedure to correct phrenic nerve stimulation secondary to cardiac resynchronization therapy. METHODS AND RESULTS Most current ways of avoiding phrenic stimulation involve either electronic reprogramming to distance the phrenic nerve from the stimulation circuit or repositioning the lead. We describe a case where the phrenic nerve was surgically insulated from the stimulating current by insinuating a patch of bovine pericardium between the epicardium and native pericardium of the heart thus completely resolving previously intolerable and incessant diaphragmatic twitch. The procedure was performed under general anaesthesia with single-lung ventilation and minimal use of neuromuscular blocking agents. Surgical patch insulation of the phrenic nerve was performed using minimally invasive VATS surgery, as a short-stay procedure, with no complications. No diaphragmatic twitch occurred post-surgery and the patient continued to gain symptomatic benefit from cardiac synchronization therapy (New York Heart Association Class III to II), enabling return to work. CONCLUSIONS In cases where the trans-venous position of a LV lead is limited by troublesome phrenic nerve stimulation, thoracoscopic surgical patch insulation of the phrenic nerve could be considered to allow beneficial cardiac resynchronization therapy.
Collapse
Affiliation(s)
- Neeraj Mediratta
- Department of Cardiac Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK
| | | | | | | | | | | |
Collapse
|
22
|
Sperzel J, Dänschel W, Gutleben KJ, Kranig W, Mortensen P, Connelly D, Trappe HJ, Seidl K, Duray G, Pieske B, Stockinger J, Boriani G, Jung W, Schilling R, Saberi L, Hallier B, Simon M, Rinaldi CA. First prospective, multi-centre clinical experience with a novel left ventricular quadripolar lead. Europace 2011; 14:365-72. [PMID: 21993431 DOI: 10.1093/europace/eur322] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) is sometimes complicated by elevated pacing thresholds and phrenic nerve stimulation (PNS), both of which may require that the coronary sinus lead be repositioned. The purpose of this study was to evaluate the performance of a novel quadripolar electrode lead and cardiac resynchronization therapy-defibrillator (CRT-D) device that enables electrical repositioning, potentially obviating a lead reposition procedure. METHODS AND RESULTS Patients indicated for CRT were enrolled and received a quadripolar electrode lead and CRT-D device (Quartetmodel 1458Q and Promote Q; St Jude Medical, Sylmar, CA, USA). Electrical data, and the presence of PNS during pacing from each left ventricular (LV) configuration, were documented at pre-hospital discharge and at 1 month. Seventy-five patients were enrolled and 71 were successfully implanted with a Quartetlead. Electrical measurements were stable over the follow-up period. Ninety-seven per cent (64 of 66) of patients had one or more programmable configurations with a threshold < 2.5 V and no PNS vs. 86% (57 of 66) if only conventional bipolar configurations were considered. Physicians were able to use the increased programming options to manage threshold changes and PNS. CONCLUSION The new quadripolar electrode LV lead provides more programming options to address common problems faced when managing CRT patients. Electrical measurements from new vectors are comparable with conventional configurations. Furthermore, 11% of patients in the study suffered PNS on all conventional bipolar vectors.
Collapse
Affiliation(s)
- Johannes Sperzel
- Cardiology Department, Kerckhoff-Klinik GmbH, Benekestr 2-8, 61231, Bad Nauheim, Germany.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
Curnis A, Bontempi L, Coppola G, Cerini M, Gennaro F, Vassanelli F, Lipari A, Ashofair N, Pagnoni C, Bisleri G, Munaretto C, Dei Cas L. Active-fixation coronary sinus pacing lead extraction: a hybrid approach. Int J Cardiol 2011; 156:e51-2. [PMID: 21907423 DOI: 10.1016/j.ijcard.2011.08.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Accepted: 08/15/2011] [Indexed: 11/29/2022]
|
24
|
Gellér L, Szilágyi S, Zima E, Molnár L, Széplaki G, Végh EM, Osztheimer I, Merkely B. Long-term experience with coronary sinus side branch stenting to stabilize left ventricular electrode position. Heart Rhythm 2011; 8:845-50. [DOI: 10.1016/j.hrthm.2011.01.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
|
25
|
Forleo GB, Della Rocca DG, Papavasileiou LP, Molfetta AD, Santini L, Romeo F. Left ventricular pacing with a new quadripolar transvenous lead for CRT: Early results of a prospective comparison with conventional implant outcomes. Heart Rhythm 2011; 8:31-7. [PMID: 20887804 DOI: 10.1016/j.hrthm.2010.09.076] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 09/23/2010] [Indexed: 11/16/2022]
Affiliation(s)
- Giovanni B Forleo
- University of Rome Tor Vergata, Department of Internal Medicine, Division of Cardiology, Rome, Italy.
| | | | | | | | | | | |
Collapse
|
26
|
|
27
|
BARANOWSKI BRYAN, YERKEY MICHAEL, DRESING THOMAS, WILKOFF BRUCEL. Fibrotic Tissue Growth into the Extendable Lobes of an Active Fixation Coronary Sinus Lead Can Complicate Extraction. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:e64-5. [DOI: 10.1111/j.1540-8159.2010.02911.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
28
|
|
29
|
Spragg DD, Dong J, Fetics BJ, Helm R, Marine JE, Cheng A, Henrikson CA, Kass DA, Berger RD. Optimal Left Ventricular Endocardial Pacing Sites for Cardiac Resynchronization Therapy in Patients With Ischemic Cardiomyopathy. J Am Coll Cardiol 2010; 56:774-81. [PMID: 20797490 DOI: 10.1016/j.jacc.2010.06.014] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2010] [Revised: 06/09/2010] [Accepted: 06/15/2010] [Indexed: 10/19/2022]
|
30
|
|