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Johnsrude C, Dasgupta S, Sobczyk W, Alsoufi B, Kozik D. Implantation of a transmural atrial pacing lead in an adult with postoperative congenital heart disease and delayed chest closure. JTCVS Tech 2024; 23:49-51. [PMID: 38352017 PMCID: PMC10859665 DOI: 10.1016/j.xjtc.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/27/2023] [Indexed: 02/16/2024] Open
Affiliation(s)
- Christopher Johnsrude
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Ky
| | - Soham Dasgupta
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Ky
| | - Walter Sobczyk
- Division of Pediatric Cardiology, Department of Pediatrics, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Ky
| | - Bahaaldin Alsoufi
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Ky
| | - Deborah Kozik
- Division of Pediatric Cardiothoracic Surgery, Department of Cardiothoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Ky
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2
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Kumar V, Kumar Nayak P, Singh Yadav M, Dhir S, Arora V, Kumar V. Alternate method for endocardial pacemaker lead implantation: A hybrid mini-thoracotomy approach. Indian Pacing Electrophysiol J 2021; 21:178-181. [PMID: 33493671 PMCID: PMC8116752 DOI: 10.1016/j.ipej.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 01/16/2021] [Accepted: 01/17/2021] [Indexed: 11/29/2022] Open
Abstract
Although the conventional methods for endo-cardial pacemaker lead implantation via subclavian or cephalic or axillary vein routes is common, but sometimes due to anatomical variations it is not feasible to access these veins Emergence of newer techniques are useful for lead implantation. This case report focuses on a hybrid approach of combined mini-thoracotomy for endocardial pacemaker lead implantation. This fluoroscopy guided minimal thoracotomy approach with endocardial MRI compatible lead placement had the benefits of simple procedural, minimal hospital stay, low early complication rates and economically viable to the patient.
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Affiliation(s)
- Viveka Kumar
- Department of Cardiology, Max Superspeciality Hospital, New Delhi, India.
| | | | | | - Sangeeta Dhir
- Department of Cardiology, Max Superspeciality Hospital, New Delhi, India.
| | - Vanita Arora
- Director & Head Electrophysiology, Max Superspeciality Hospital, New Delhi, India.
| | - Vivek Kumar
- Department of Cardiology, Max Superspeciality Hospital, New Delhi, India.
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3
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Alfie A, Speranza R, Ramos Barrios A, de Zuloaga C, Vergara G, Costa G. Postero-lateral intermuscular transvenous ICD insertion: a novel approach for device implantation in challenging scenarios. J Interv Card Electrophysiol 2020; 61:429-430. [PMID: 33201369 DOI: 10.1007/s10840-020-00917-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/10/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Alberto Alfie
- Electrophysiology Section, Cardiology Division, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Moron, Province of Buenos Aires, Argentina.
| | - Ricardo Speranza
- Electrophysiology Section, Cardiology Division, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Moron, Province of Buenos Aires, Argentina
| | - Amilcar Ramos Barrios
- Electrophysiology Section, Cardiology Division, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Moron, Province of Buenos Aires, Argentina
| | - Claudio de Zuloaga
- Electrophysiology Section, Cardiology Division, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Moron, Province of Buenos Aires, Argentina
| | - Gaston Vergara
- Electrophysiology Section, Heart Center of Nevada, Las Vegas, NV, USA
| | - Gustavo Costa
- Electrophysiology Section, Cardiology Division, Hospital Nacional Profesor Alejandro Posadas, El Palomar, Moron, Province of Buenos Aires, Argentina
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4
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Bogush N, Espinosa RE, Cannon BC, Wackel PL, Okamura H, Friedman PA, McLeod CJ. Selecting the right defibrillator in the younger patient: Transvenous, epicardial or subcutaneous? Int J Cardiol 2018; 250:133-138. [DOI: 10.1016/j.ijcard.2017.09.213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 09/16/2017] [Accepted: 09/29/2017] [Indexed: 01/22/2023]
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5
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Epstein LM, Maytin M. Strategies for Transvenous Lead Extraction Procedures. J Innov Card Rhythm Manag 2017; 8:2702-2716. [PMID: 32494448 PMCID: PMC7252922 DOI: 10.19102/icrm.2017.080502] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/05/2017] [Indexed: 11/29/2022] Open
Abstract
Transvenous lead extraction (TLE) has undergone an explosive evolution since its inception as a rudimentary skill with limited technology and therapeutic options. Early techniques involved simple manual traction that frequently proved ineffective for chronically implanted leads, and carried a significant risk of myocardial avulsion, tamponade, and death. The morbidity and mortality associated with these early extraction techniques limited their application to use only in life-threatening situations, such as infection and sepsis. The past four decades, however, have witnessed significant advances in lead extraction technology, resulting in more efficacious techniques and tools, providing the skilled extractor with a well-equipped armamentarium. With the development of the discipline, we have witnessed a growth in the community of TLE experts coincident with a marked decline in the incidence of procedure-related morbidity and mortality, with recent registries at high-volume centers reporting high success rates with exceedingly low complication rates. Future developments in lead extraction are likely to focus on new tools that will allow for us to provide comprehensive device management, develop alternative systems for extraction training, and focus on the design of new leads conceived to facilitate future extraction.
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Affiliation(s)
- Laurence M Epstein
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Melanie Maytin
- Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
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6
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Williams MR, Shepard SM, Boramanand NK, Lamberti JJ, Perry JC. Long-term follow-up shows excellent transmural atrial lead performance in patients with complex congenital heart disease. Circ Arrhythm Electrophysiol 2014; 7:652-7. [PMID: 24907290 DOI: 10.1161/circep.113.001321] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many patients with congenital heart disease require permanent pacing for rhythm management but cannot undergo transvenous lead placement. In others, epicardial scarring prohibits adequate sensing and pacing thresholds using epicardial leads. This study describes long-term lead performance using a transmural atrial (epicardial to endocardial) pacing approach in patients with congenital heart disease. METHODS AND RESULTS For transmural atrial (TMA) lead access, a bipolar, steroid-eluting transvenous lead was placed from the epicardium via purse-string incision or atriotomy and affixed to atrial endocardium. Records were reviewed for patient data and acute and long-term lead performance for TMA leads placed 1998 to 2004. Forty-two of 48 TMA leads remain active at last follow-up. Two leads fractured, 4 were functional at >5-year follow-up but no longer active. Freedom from lead failure 98% (95% confidence interval, 86%-100%) at mean follow-up 7.8 years. TMA leads gave excellent sensing and pacing characteristics at implant and chronically. Median acute and chronic sensing thresholds were 3 and 2.8 mV, respectively; median acute and chronic pacing thresholds at 0.5 ms were 0.9 and 0.7 V, respectively. TMA leads performed similarly in Fontan patients. Overdrive pacing for intra-atrial re-entrant tachycardia was successful in 7 of 8 patients. One patient with high baseline risk died of stroke 7 years after implant. No lead-associated thrombi were observed. CONCLUSIONS TMA pacing leads had excellent longevity, initial, and chronic functional properties and provide an alternative to epicardial leads in patients with congenital heart disease. Patients who cannot receive transvenous leads, have epicardial scarring or have intra-atrial re-entrant tachycardia could benefit most from routine use of this technique.
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Affiliation(s)
- Matthew R Williams
- From the Department of Pediatrics, Division of Cardiology (M.R.W., S.M.S., N.K.B., J.C.P.), and Department of Surgery, Division of Pediatric Cardiac Surgery (J.J.L.), University of California, San Diego and Rady Children's Hospital, San Diego, CA.
| | - Suzanne M Shepard
- From the Department of Pediatrics, Division of Cardiology (M.R.W., S.M.S., N.K.B., J.C.P.), and Department of Surgery, Division of Pediatric Cardiac Surgery (J.J.L.), University of California, San Diego and Rady Children's Hospital, San Diego, CA
| | - Nicole K Boramanand
- From the Department of Pediatrics, Division of Cardiology (M.R.W., S.M.S., N.K.B., J.C.P.), and Department of Surgery, Division of Pediatric Cardiac Surgery (J.J.L.), University of California, San Diego and Rady Children's Hospital, San Diego, CA
| | - John J Lamberti
- From the Department of Pediatrics, Division of Cardiology (M.R.W., S.M.S., N.K.B., J.C.P.), and Department of Surgery, Division of Pediatric Cardiac Surgery (J.J.L.), University of California, San Diego and Rady Children's Hospital, San Diego, CA
| | - James C Perry
- From the Department of Pediatrics, Division of Cardiology (M.R.W., S.M.S., N.K.B., J.C.P.), and Department of Surgery, Division of Pediatric Cardiac Surgery (J.J.L.), University of California, San Diego and Rady Children's Hospital, San Diego, CA
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7
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KONERU JAYANTHIN, ELLENBOGEN KENNETHA. High-Risk Lead Extraction Using a Hybrid Approach: The Blade and the Lightsaber. J Cardiovasc Electrophysiol 2014; 25:622-3. [DOI: 10.1111/jce.12380] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- JAYANTHI N. KONERU
- Division of Cardiology; Department of Medicine; Medical College of Virginia/VCU School of Medicine; Richmond Virginia USA
| | - KENNETH A. ELLENBOGEN
- Division of Cardiology; Department of Medicine; Medical College of Virginia/VCU School of Medicine; Richmond Virginia USA
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8
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Costa R, Scanavacca M, da Silva KR, Martinelli Filho M, Carrillo R. Novel approach to epicardial pacemaker implantation in patients with limited venous access. Heart Rhythm 2013; 10:1646-52. [DOI: 10.1016/j.hrthm.2013.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Indexed: 10/26/2022]
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9
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Sivakumar K, Coelho R. Novel Technique of Dual Chamber Pacing Through Minithoracotomy and Transatrial Endocardial Active Fixation Lead Insertion for Epicardial Pacing Lead Malfunction. Indian Pacing Electrophysiol J 2013; 13:170-2. [PMID: 24130425 PMCID: PMC3775320 DOI: 10.1016/s0972-6292(16)30668-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Epicardial pacing lead fixation is employed in patients with cavopulmonary anastamosis (Glenn shunts) when they need permanent pacing. Epicardial pacing in these patients may malfunction due to high pacing thresholds or diaphragmatic pacing. A novel technique of transatrial insertion of two endocardial screw-in pacing leads through right anterolateral minithoracotomy could achieve synchronous atrioventricular pacing in a patient with Ebsteins anomaly with symptomatic sinoatrial and atrioventricular nodal disease.
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10
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Axillary subpectoral approach for pacemaker or defibrillator implantation in patients with ipsilateral prepectoral infection and limited venous access. J Interv Card Electrophysiol 2009; 27:137-42. [PMID: 19937100 DOI: 10.1007/s10840-009-9444-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2009] [Accepted: 09/14/2009] [Indexed: 11/25/2022]
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11
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Endovascular bi-ventricular pacing-defibrillator placement using a trans-atrial approach. J Interv Card Electrophysiol 2009; 27:143-5. [PMID: 19543961 DOI: 10.1007/s10840-009-9403-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 04/01/2009] [Indexed: 10/20/2022]
Abstract
Venous access for pectoral pacemaker and defibrillator lead placement can be compromised by venous occlusion due to previous pacing leads, access ports for medications such as chemotherapy, dialysis access, and other causes. On rare occasion, a femoral access is utilized for device placement. We report here a patient without venous access to the heart from either above or below due to retroperitoneal fibrosis. A bi-ventricular pacing-defibrillator was placed using a direct trans-atrial approach with good results. This minimally invasive approach to device placement may be useful in patients with poor venous access and avoids the placement of epicardial hardware.
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12
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Kamdar RH, Schilling RJ. Percutaneous permanent pacemaker implantation via the azygous vein in a patient with superior vena cava occlusion. Pacing Clin Electrophysiol 2008; 31:386-8. [PMID: 18307638 DOI: 10.1111/j.1540-8159.2008.01003.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Occlusion of the superior vena cava (SVCO) makes implantation of permanent pacemakers challenging and difficult. We describe an extended application of a Medtronic Attain (Medtronic Inc., Minneapolis, MN, USA) guide catheter (a tool designed for delivery of left ventricular pacing leads into the coronary sinus) for delivery of a right ventricular pacing lead via the azygous vein in a 72-year-old woman with SVCO secondary to long-term central venous hemodialysis catheters. This approach allowed the use of an endocardial pacing lead, implantation under local anesthesia, and conventional positioning of the pacemaker generator in the pectoral region in a patient with SVCO.
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Affiliation(s)
- Ravindu Hasmukh Kamdar
- Department of Cardiology, St. Bartholomew's Hospital, Dominion House, 60 Bartholomew Close, West Smithfield, London EC1A 7BE, UK
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13
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Brueck M, Bandorski D, Kramer W, Rauber K. Inferior vena cava approach to permanent pacemaker implantation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:813-6. [PMID: 17547621 DOI: 10.1111/j.1540-8159.2007.00759.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 89-year-old woman required permanent pacemaker implantation because of symptomatic bradyarrhythmia with multiple falls and repeated fractures. Because of the obstruction of the thoracic veins and infection of both groins, an alternative approach via directly punctured inferior vena cava was performed. At follow-up, the patient remained well with an excellent symptomatic response to pacing. The method seems simple to perform and is an alternative when the usual pectoral implantation site is inaccessible.
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Affiliation(s)
- Martin Brueck
- Department of Cardiology, Hospital of Wetzlar, Wetzlar, Germany.
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14
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Lau EW. Upper Body Venous Access for Transvenous Lead Placement?Review of Existent Techniques. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:901-9. [PMID: 17584273 DOI: 10.1111/j.1540-8159.2007.00779.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Recent developments in permanent pacemaker and implantable cardioverter-defibrillator therapy have focused on the endocardial placement sites of leads ("selective site pacing"), detection and pacing algorithms, and indications for device therapy. In comparison, the surgical and venous access aspects of device therapy have received relatively little attention. Obtaining central venous access is a prerequisite for delivering device therapy through transvenously placed leads. This article reviews the different techniques available for obtaining upper body venous access for transvenous lead placement, even though the information will also be relevant to other specialties that require central venous access for other purposes.
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Affiliation(s)
- Ernest W Lau
- Department of Cardiology, Royal Victoria Hospital, Belfast, UK.
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15
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Dixit S, Marchlinski FE. Cardiac Pacemakers. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Pua BB, Saunders PC, Lapietra A, Colvin SB, Collins J, Grossi EA. Transatrial dual chamber biventricular pacemaker-defibrillator placement in a patient with SVC obstruction. Pacing Clin Electrophysiol 2003; 26:2045-7. [PMID: 14516350 DOI: 10.1046/j.1460-9592.2003.00317.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A patient with severe congestive heart failure and obstruction of the superior vena cava required biventricular pacing and ICD therapy. Via right minithoracotomy, a transatrial approach for lead placement was successfully utilized to provide cardiac resynchronization and ICD placement. This technique for pacing lead placement is reviewed and its application for biventricular pacemaker-defibrillator placement is reported.
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Affiliation(s)
- Bradley B Pua
- Division of Cardiothoracic Surgery, New York University School of Medicine, New York, New York 10028, USA
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17
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Parsonnet V, Roelke M. The cephalic vein cutdown versus subclavian puncture for pacemaker/ICD lead implantation. Pacing Clin Electrophysiol 1999; 22:695-7. [PMID: 10353126 DOI: 10.1111/j.1540-8159.1999.tb00531.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Goldstein DJ, Rabkin D, Spotnitz HM. Unconventional approaches to cardiac pacing in patients with inaccessible cardiac chambers. Ann Thorac Surg 1999; 67:952-8. [PMID: 10320234 DOI: 10.1016/s0003-4975(99)00150-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Transvenous endocardial implantation can be impossible or contraindicated in patients with inaccessible right cardiac chambers. These patients usually undergo epicardial implantation, which has been associated with frequent rising thresholds and limited lead survival. We have used the following two alternative approaches in these patients: (1) transatrial puncture and passage of pacing leads for patients with no access to the right atrium and (2) ventricular pacing from the coronary sinus or its tributaries for patients with inaccessible ventricles. METHODS. We retrospectively reviewed our experience in 9 patients who had those procedures. Five patients had pacing from the coronary sinus, and 4 by transatrial puncture. RESULTS Seven of the 9 patients had DDD pacing. Low acute pacing thresholds and satisfactory sensing levels were obtained with both approaches. One instance of high stimulation threshold (20%) occurred in the coronary sinus group and none in the transatrial puncture group. One patient in the transatrial puncture group died from unrelated causes. No malignant arrhythmias, pneumothorax, diaphragmatic pacing, or infectious complications have been observed. CONCLUSION These unconventional approaches are safe, relatively simple, and reliable. Although the short-term follow-up is favorable, long-term follow-up is necessary to ascertain the relative merit of these approaches.
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Affiliation(s)
- D J Goldstein
- Department of Surgery, College of Physicians & Surgeons, Columbia University, New York, New York 10032, USA.
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Johnsrude CL, Backer CL, Deal BJ, Strasburger JF, Mavroudis C. Transmural atrial pacing in patients with postoperative congenital heart disease. J Cardiovasc Electrophysiol 1999; 10:351-7. [PMID: 10210497 DOI: 10.1111/j.1540-8167.1999.tb00682.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Some patients with postoperative congenital heart disease require permanent cardiac pacing, but the use of transvenous or epicardial pacing leads may be limited by type of cardiac malformation, venous connections, body size, or fibrosis. Transmural atrial pacing may provide an alternative in difficult patients, but to date has been described in only a few articles with small patient numbers, and data from lead performance are lacking. METHODS AND RESULTS Records were reviewed in 18 consecutive patients (4 months to 21 years old) with postoperative congenital heart disease receiving transmural atrial pacing leads from July 1994 to December 1996. Implantation materials and techniques were described. Lead sensing and capture thresholds obtained acutely and during short-term follow-up (mean: 11.0 months) were evaluated, and comparisons were made between patients with postoperative Fontan anatomy and non-Fontan patients, and between patients receiving steroid-eluting and nonsteroid leads. Overall, the median acute sensing and capture thresholds of transmural leads were 4.1 m V and 0.7 V at 0.5 msec, respectively. Median follow-up thresholds were 2.8 m V and 0.8 V, respectively. Performance of leads in Fontan patients was similar to those in non-Fontan patients. Steroid-eluting leads had a chronic capture threshold of 0.6 V versus 0.9 V for nonsteroid leads (P = 0.038). CONCLUSION Transmural atrial pacing leads were successfully implanted in patients with diverse ages and types of postoperative congenital heart disease. Lead performance was acceptable both acutely and during the first year of follow-up.
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Affiliation(s)
- C L Johnsrude
- Department of Pediatrics, Northwestern University Medical School, Children's Memorial Hospital, Chicago, Illinois 60614, USA
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20
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Epstein MR, Walsh EP, Saul JP, Triedman JK, Mayer JE, Gamble WJ. Long-term performance of bipolar epicardial atrial pacing using an active fixation bipolar endocardial lead. Pacing Clin Electrophysiol 1998; 21:1098-104. [PMID: 9604242 DOI: 10.1111/j.1540-8159.1998.tb00156.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Bipolar epicardial leads are not yet widely available for atrial use. Since September 1986, we have used a bipolar active fixation endocardial lead (Cardiac Pacemakers model number's 4266, 4268, and 4269) as a bipolar epicardial atrial lead by attaching the corkscrew tip to the atrial surface and imbricating atrial tissue around the more proximal electrode. A total of 77 bipolar epicardial atrial leads have been implanted using this approach in 72 patients with congenital heart disease (ages 3 months to 38.7 years; mean 8.9 +/- 8.8 years). Indications for atrial pacing included AV block (n = 46), sinus node dysfunction (n = 17), and antitachycardial pacing (n = 9). Indications for epicardial pacing included the presence of an intracardiac right to left shunt (n = 33), concomitant cardiac surgery (n = 26), surgeon preference (n = 7), and lack of transvenous access to the atrial endocardium (n = 6). Follow-up (median 23 months; mean 28.0 +/- 23.1 months; range 1-78 months) data beyond 1 month postimplantation were available for 44 leads. Atrial sensing was > or = 2.0 mV for 26 leads (59%) with sensing possible at > or = 0.75 mV for 42 leads (95%). Threshold data were available at 5 V for 37 leads and at 2.5 V for 36 leads with mean pulse width thresholds measuring 0.21 +/- 0.33 ms and 0.34 +/- 0.34 ms, respectively. Two leads failed (high capture thresholds at 5 days [n = 1], lead fracture at 42 months [n = 1]; one of which was replaced. Four additional leads were replaced electively (marginal thresholds [n = 1], intermittent phrenic nerve stimulation [n = 1], damaged during subsequent surgery [n = 1], clinically irrelevant insulation break [n = 1]) concomitant with additional cardiac surgery. Until a commercially available lead is developed and released, improvisation with a bipolar active fixation endocardial lead as a bipolar epicardial atrial lead is a reasonable approach to providing bipolar atrial sensing and pacing in patients for whom endocardial pacing is contraindicated.
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Affiliation(s)
- M R Epstein
- Children's Hospital, Department of Cardiology, Boston, Massachusetts 02115, USA
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Abstract
The extrathoracic approach to transvenous introducer insertion into the subclavian vein was initially described as an alternative approach in "Safe Introducer Technique for Pacemaker Lead Implantation." Since this technique was so successful as an alternative approach, it was tried as the primary approach in 213 consecutive cases. The subclavian vein was cannulated in all cases. There were no introducer related complications. The extrathoracic approach cannulates the subclavian vein as it passes over the body of the first rib prior to entering the thoracic inlet. The technique includes maneuvering the introducer needle from the clavicle to the first rib by a series of partial withdrawals and reinsertions, visualized by fluoroscopy. The needle is advanced posteriorly along the rib until the vein is punctured. Orientation is maintained by touching the rib with each maneuver. The early results of the extrathoracic approach reinforces the belief that a complication-free, transvenous introducer approach can be achieved.
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Affiliation(s)
- C L Byrd
- University of Miami School of Medicine, Florida
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23
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Antonelli D, Freedberg NA, Rosenfeld T. Transiliac vein approach to a rate responsive permanent pacemaker implantation. Pacing Clin Electrophysiol 1993; 16:1751-2. [PMID: 7690945 DOI: 10.1111/j.1540-8159.1993.tb01047.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 60-year-old patient was admitted for elective replacement of a depleted pulse generator. The pacemaker was implanted 5 years before because of sick sinus syndrome and it was connected to an epicardial lead due to total occlusion of the superior vena cava. The pacing threshold of the epicardial electrode was unacceptably high, so an endocardial lead was inserted through the iliac vein. The lead was connected to a VVIR pacemaker, which was located in the abdomen just lateral to the umbilicus. During a 1-year follow-up period, the patient felt well and pacemaker performance was satisfactory.
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Affiliation(s)
- D Antonelli
- Department of Cardiology, Central Emek Hospital, Afula, Israel
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Kerstjens-Frederikse MW, Bink-Boelkens MT, de Jongste MJ, Homan van der Heide JN. Permanent cardiac pacing in children: morbidity and efficacy of follow-up. Int J Cardiol 1991; 33:207-14. [PMID: 1743780 DOI: 10.1016/0167-5273(91)90348-s] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The data from 50 permanently paced children [mean standard deviation follow-up 5.3 +/- 3.7 years] were reviewed, with special attention being paid to the cause of complications and the efficacy of follow-up. The 5-year survival (SD) of the patients was 78 +/- 6%; mortality was mainly due to the underlying cardiac disease. The 5-year survival (SD) of the pacing systems was 48 +/- 8%. Surgical interventions were necessary every 4.9 patient years. Of these interventions, 58% were caused by lead-related problems. Epicardial leads showed significantly more exit blocks and high thresholds than endocardial leads. Endocardial leads, therefore, should be used at a younger age than is now the current practice, from 5 years of age onwards, for example. If epicardial leads are used, the pacemaker must have a high output facility. Since exit block occurred only within the first 3 months after implantation, we suggest frequent transtelephonic monitoring during the first 3 months. Holter monitoring appeared to be the most effective and sensitive method of detecting malsensing and should be performed regularly.
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