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Su L, Xu T, Cai M, Xu L, Vijayaraman P, Sharma PS, Chen X, Zheng R, Wu S, Huang W. Electrophysiological characteristics and clinical values of left bundle branch current of injury in left bundle branch pacing. J Cardiovasc Electrophysiol 2020; 31:834-842. [PMID: 32009260 DOI: 10.1111/jce.14377] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Lan Su
- Department of CardiovascularThe First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- The Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
| | - Tiancheng Xu
- Department of CardiovascularThe First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- The Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
| | - Mengxing Cai
- Department of CardiovascularThe First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- The Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
| | - Lei Xu
- Department of CardiovascularThe First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- The Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
| | | | - Parikshit S. Sharma
- Section of CardiologyRush Heart Center for Women, Rush University Chicago Illinois
| | - Xiao Chen
- Department of CardiovascularThe First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- The Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
| | - Rujie Zheng
- Department of CardiovascularThe First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- The Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
| | - Shengjie Wu
- Department of CardiovascularThe First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- The Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
| | - Weijian Huang
- Department of CardiovascularThe First Affiliated Hospital of Wenzhou Medical University Wenzhou China
- The Key Lab of Cardiovascular Disease of Wenzhou Wenzhou China
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Zhuang L, Mao Y, Wu L, Niu W, Chen K. Effects of right ventricular septum or His-bundle pacing versus right ventricular apical pacing on cardiac function: A systematic review and meta-analysis of randomized controlled trials. J Int Med Res 2018; 46:3848-3860. [PMID: 29962274 PMCID: PMC6136004 DOI: 10.1177/0300060518781415] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Objective Recent studies have demonstrated that right ventricular apical
(RVA) pacing has a deleterious impact on left ventricular
function, while right ventricular septum (RVS) or His-bundle
pacing (HBP) contribute to improvements in cardiac function. A
meta-analysis of randomized controlled trials (RCTs) was
conducted to compare the mid- and long-term effects of RVS and
HB pacing versus RVA pacing on cardiac function. Methods Eligible RCTs were identified by systematically searching the
electronic literature databases PubMed®, Cochrane Library,
Embase® and Ovid®. Results Seventeen articles (n = 1290 patients) were
included in this meta-analysis, including 14 studies comparing
the effects of RVA and RVS pacing on cardiac function and three
studies comparing HBP with pacing at other sites. Compared with
RVA pacing, RVS or HBP exhibited a higher left ventricular
ejection fraction (LVEF) (weighted mean difference 3.28; 95%
confidence interval 1.45, 5.12) at the end of follow-up. Conclusions RVS pacing exhibited a higher LVEF after long-term follow-up than
RVA pacing. RVS pacing could replace the previously used RVA
pacing as a better alternative with improved clinical outcomes.
However, there remains a need for larger RCTs to compare the
safety and efficacy of RVS with RVA pacing.
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Affiliation(s)
- Lingfang Zhuang
- 1 Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Ye Mao
- 2 Outpatient Department, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqun Wu
- 1 Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenquan Niu
- 3 Shanghai Institute of Hypertension, Shanghai, China
| | - Kang Chen
- 1 Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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Nanostim leadless pacemaker system: A longer waiting period after active fixation may reduce unnecessary repositioning. HeartRhythm Case Rep 2018; 4:63-65. [PMID: 29876290 PMCID: PMC5988471 DOI: 10.1016/j.hrcr.2017.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Hao Y, Li Y, Liao D, Yang L, Liu F. A comparative analysis of the effectiveness of active versus passive atrial lead fixation in Chinese patients with cardiac implantable electrical devices: a long term, retrospective, observational, single-center study. Curr Med Res Opin 2017; 33:573-578. [PMID: 28008765 DOI: 10.1080/03007995.2016.1275938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Data comparing active atrial lead fixation with passive atrial lead fixation in Chinese patients with cardiovascular implantable electronic devices (CIEDs) for atrial pacing is limited. Our study evaluated the effectiveness of active fixation versus passive fixation of atrial leads by observing the lead performance parameters. METHODS This retrospective, long-term, single-center study included a cohort of Chinese patients who underwent CIED implantation at the Department of Cardiology of People's Hospital of Yuxi City, China, from 1 March 2010 to 1 March 2015. Efficacy was determined by comparing implantation time, threshold values, incidence of lead dislocation/failure, and lead-related complications between the two groups. RESULTS Of the 1217 patients, active and passive atrial lead fixation were performed in 530 (mean age, 69.37 ± 11.44 years) and 497 (mean age, 68.33 ± 10.96 years). The active fixation group reported significantly lower mean atrial implantation times (P = .0001) and threshold values (P = .044) compared with the passive atrial lead fixation group. In addition, threshold values in the active atrial lead fixation group were stable throughout the observation period. No instances of myocardial perforation, cardiac tamponade, implantation failure, or electrode dislocation/re-fixation were reported in the active atrial lead fixation group. A favorable decrease in patient comfort parameters such as bed rest time (P = .027) and duration of hospital stay (P = .038) were also observed in the active lead fixation group. CONCLUSION Active atrial lead fixation demonstrated greater stability, steady long-term thresholds and minimal lead-related complications compared to passive lead fixation in Chinese patients with CIEDs.
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Affiliation(s)
- Yinglu Hao
- a Department of Cardiology , People's Hospital of Yuxi City , Yuxi , China
| | - Yanping Li
- a Department of Cardiology , People's Hospital of Yuxi City , Yuxi , China
| | - Derong Liao
- a Department of Cardiology , People's Hospital of Yuxi City , Yuxi , China
| | - Ling Yang
- a Department of Cardiology , People's Hospital of Yuxi City , Yuxi , China
| | - Fangyan Liu
- a Department of Cardiology , People's Hospital of Yuxi City , Yuxi , China
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A long-term, prospective, cohort study on the performance of right ventricular pacing leads: comparison of active-fixation with passive-fixation leads. Sci Rep 2015; 5:7662. [PMID: 25563218 PMCID: PMC4288218 DOI: 10.1038/srep07662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 12/03/2014] [Indexed: 11/24/2022] Open
Abstract
Active-fixation pacing leads allow the use of selective pacing sites. We evaluated their long-term performance versus passive-fixation leads in 199 newly implanted patients (n = 100 active and n = 99 passive). Postoperative pacing thresholds in the active group were higher than in the passive group (0.85 ± 0.31 V vs. 0.53 ± 0.21 V at baseline, P < 0.001). The active thresholds fell to 0.72 ± 0.23 V at 5 years with a significant drop at one month (0.68 ± 0.53 V, P = 0.003). The passive thresholds slightly increased to 0.72 ± 0.31 V at five years. Differences between groups were significant until three years (all P < 0.05). Active impedances were generally lower than passive impedances (600.44 ± 94.31Ω vs. 683.14 ± 110.98Ω at baseline), and both showed significant reductions at one month to 537.96 ± 147.43Ω in the active group, and after three months to 643.85 ± 82.40Ω in the passive group (both P < 0.01 vs. baseline). Impedance differences between groups were significant until four years (all P < 0.05). Adverse events included thresholds over 1 V, 5 of 6 active and 2 of 5 passive leads returned to below 1 V. One active left ventricular lead dislodged. One passive left subclavian lead insulation fracture occurred. Thus Active fixation pacing leads are stable in a five-year long-term follow up. There was no difference between active and passive leads in terms of electrical performance.
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Mond HG, Helland JR, Stokes K, Bornzin GA, McVenes R. The electrode-tissue interface: the revolutionary role of steroid-elution. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2014; 37:1232-49. [PMID: 25130977 DOI: 10.1111/pace.12461] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 05/08/2014] [Accepted: 06/04/2014] [Indexed: 11/29/2022]
Abstract
The electrode-tissue interface is that area lying between the cathode of a low-voltage implantable pacemaker or cardioverter-defibrillator (ICD) lead and the endocardium or epi-myocardium of the cardiac chamber being paced. The electrical stimulus that is delivered to this interface is responsible for myocyte depolarization with consequent cardiac contraction. The process by which this occurs is reasonably well understood and any explanation requires a basic understanding of the physics and cellular electrophysiology of pacing. The effective and efficient delivery of electrical energy to the myocardium via the lead is dependent on many factors to be discussed in this review. However, despite numerous evolutionary changes occurring in the cathode's material, design, and surface configuration, it was not until the incorporation of steroid-elution to the electrode-tissue interface that reliable and significantly low stimulation threshold cardiac pacing became possible.
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Affiliation(s)
- Harry G Mond
- Department of Cardiology, The Royal Melbourne Hospital and Department of Medicine, the University of Melbourne, Australia
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Herrlich S, Spieth S, Gerstmann H, Virnich A, Zipfel F, Kitschmann A, Goettsche T, Osypka P, Zengerle R. Drug release mechanisms of steroid eluting rings in cardiac pacemaker lead electrodes. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2013; 2012:681-4. [PMID: 23365984 DOI: 10.1109/embc.2012.6346023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper reports on the drug release mechanisms of silicone structures with embedded steroids applied in pacing leads. Different derivatives of the steroid dexamethasone, which is associated with the reduction of acute stimulation thresholds, were evaluated together with different matrix based release control mechanisms with the target to potentially match optimal drug release rates during the first month after implantation. By incorporating dexamethasone-21-dihydrogen phosphate in silicone matrices in combination with release rate adaption layers, almost continuous release rates were obtained under physiological test settings.
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Affiliation(s)
- Simon Herrlich
- Institut für Mikround Informationstechnik der Hahn-Schickard-Gesellschaft e.V. (HSG-IMIT), Villingen-Schwenningen, Germany.
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Weizong W, Zhongsu W, Yujiao Z, Mei G, Jiangrong W, Yong Z, Xinxing X, Yinglong H. Effects of right ventricular nonapical pacing on cardiac function: a meta-analysis of randomized controlled trials. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1032-51. [PMID: 23438131 DOI: 10.1111/pace.12112] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Revised: 12/18/2012] [Accepted: 01/13/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND A meta-analysis of randomized controlled trials (RCTs) was conducted to compare the effects of right ventricular nonapical (RVNA) and right ventricular apical (RVA) pacing on cardiac function. METHODS A systematic literature search was performed using MEDLINE, EMBASE, and the Cochrane Library to identify RCTs comparing RVNA pacing with RVA pacing with follow-up ≥2 months. Twenty RCTs involving 1,114 patients were included. RESULTS Compared with RVA pacing, RVNA (mainly right ventricular septum [RVS]) pacing exhibited not only excellent pacing threshold and R-wave amplitude but also higher impedance. RVNA pacing showed a significant increase in left ventricular ejection fraction (LVEF) at the end of follow-up (weighted mean difference = 3.58, 95% confidence interval = 1.80-5.35), and the effects were observed in the following subgroups: 6-month follow-up, ≤12-month follow-up, >12-month follow-up, baseline LVEF ≤45%, and baseline LVEF >45%. RVS and RVA pacing significantly differed in improving LVEF (weighted mean difference = 4.82, 95% confidence interval = 2.78-6.87). In addition, RVNA pacing resulted in a narrower QRS duration, a smaller left ventricular end-systolic volume, and a lower New York Heart Association functional class. CONCLUSIONS This meta-analysis found that RVNA (mainly RVS) pacing exhibited satisfactory long-term lead performance compared with RVA pacing and demonstrated beneficial effects in improving LVEF after the 6-month follow-up. Furthermore, it proved superior to RVA pacing in terms of interventricular synchrony and cardiac function.
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Affiliation(s)
- Wang Weizong
- Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Jinan City, China
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Sun JL, Han R, Guo JH, Li XY, Ma XL, Wang CY. Effects of ibutilide on canine cardiac pacing threshold and on induction rates of atrial fibrillation. Cell Biochem Biophys 2012; 64:197-203. [PMID: 22740072 DOI: 10.1007/s12013-012-9372-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study aims to observe the effects of ibutilide on canine cardiac pacing threshold and on induction rates of atrial fibrillation. Eighteen mongrel dogs were anesthetized and administrated with ibutilide. The pacing thresholds and induction rates of atrial fibrillation were measured with and without ibutilide (10-min infusion dose was 0.10 mg kg(-1), followed by a maintaining dose of 0.01 mg min(-1) 30 min later). This study found that ibutilide increases pacing thresholds in dogs. Moreover, there were significant differences between pacing thresholds with and without ibutilide (P < 0.05). Further, ibutilide significantly reduces the induction rates of atrial fibrillation (P < 0.05). Our findings indicate that pacing voltage changes should be closely monitored in patients taking anti-arrhythmic drugs, who are treated with cardiac stimulation or have undergone pacemaker implantation. We also found that ibutilide is an effective drug in preventing or controlling atrial fibrillation.
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Affiliation(s)
- Jian-ling Sun
- Department of Cardiology, Aviation General Hospital, An Ding Men Wai Bei Yuan Road 3, Beijing 100012, China.
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Kashiwase K, Kobayashi H, Hirata A, Wada M, Nakanishi H, Ueda Y. Acute changes in the pacing threshold after lead implantation. Comparison between retractable and sweet-tip active-fixation leads. Int Heart J 2012; 53:108-12. [PMID: 22688314 DOI: 10.1536/ihj.53.108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although the pacing threshold of steroid-eluting active-fixation leads remains stable over the long term, it changes rapidly after screw-in. We compared the pacing threshold in the acute phase between retractable and Sweet-Tip active-fixation leads. We studied 132 patients who were implanted with active-fixation leads for new pacemaker implantation or additional leads required due to disconnected/leaking leads. Pacing threshold was measured at 4 time points: before screw-in, immediately, and 5 and 10 minutes after screw-in. If the pacing threshold was > 1.5 volts (V) at 5 minutes, we changed the pacing site so that it became ≤ 1.5 V. A total of 169 retractable leads (Medtronic: 107 leads, St. Jude Medical: 62 leads) and 33 Sweet-Tip leads (Boston: 33 leads) were implanted. Eighty-nine leads were implanted in the atrium and 113 leads in the ventricle. Seventy patients were implanted with both atrial and ventricular leads. The pacing threshold of Sweet-Tip leads increased immediately after screw-in, while that of retractable leads decreased (Sweet-Tip: 0.20 ± 0.57 V, Retractable: -0.15 ± 0.53 V, P < 0.05). The pacing threshold of both types of leads decreased similarly from immediately to 5 minutes after screw-in (Sweet Tip: -0.29 ± 0.43 V, Retractable: -0.25 ± 0.36 V, P = NS). Few changes in the threshold were detected between 5 and 10 minutes. Because the pacing threshold of Sweet-Tip active-fixation leads increased immediately after screw-in and that of both type leads decreased from immediately to 5 minutes, we should measure the pacing threshold from 5 minutes after screw-in.
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Canabal A, Hortigüela V, Raigal A, Sánchez P, Sánchez M, Marco C, Fernández E, Márquez JA. [Foreseeable variation in parameters measured at implant and follow-up of permanent pacemaker active fixation electrodes]. Med Intensiva 2011; 36:270-6. [PMID: 22192317 DOI: 10.1016/j.medin.2011.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Revised: 10/18/2011] [Accepted: 11/01/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To analyze the variations in the parameters relative to active fixation electrodes at the time of implantation and over subsequent follow-up during 6 months of the acute phase of implantation. DESIGN A descriptive, analytical, prospective, observational cohort study was made of consecutive cases over a period of 8 months (April-December 2010). SETTING Pacing unit of an Intensive Care Unit. PATIENTS OR PARTICIPANTS Patients undergoing permanent pacemaker implantation with active fixation electrodes, implanted in both atrium and ventricle, Interventions: Measurement of variables described with a threshold analyzer during electrode fixation and at different times during the study, Main compared variables: threshold, impedance and intrinsic activity (both atrial and ventricular) before and after fixation, at 48 hours, at one month and 6 months, Comparisons were made using the Student t-test for paired data, assuming significance for p<0,05, and ANOVA to analyze the successive changes over ambulatory follow-up. RESULTS We analyzed 40 patients, with 19 atrial and 40 ventricular electrodes, In fixation, the electrodes showed significant variation in the impedance values of the atrial lead (1,188,53 ± 397,26 vs 610,69 ± 326,30 ohms, p<0,0001) and ventricular lead (1,512,93 ± 718,07 vs 768,80 ± 224,90 ohms, p>0,0001), In the first 48 hours it was coupled with a decrease in ventricular (0,86 ± 0,35 vs 0,48 ± 0,23 volts, p = 0,0001) and atrial pacing threshold (1,10 ± 0,39 vs 0,43 ± 0,23 volts, p = 0,0003), and p-wave sensing (3,61 ± 2,25 vs 2,32 ± 1,09 mV, p = 0,0463), Over follow-up we found the parameters to be stable, with no significant changes. CONCLUSIONS After active lead fixation, a fall in impedance of the antrial and ventricular is expected, Over the next 48 hours improvement in atrial and ventricular threshold may occur, in contrast to the sensitivity of the intrinsic activity, which reached significance at the P wave measured after 48 hours, These values stabilize over patient follow-up and do not differ significantly in the studied acute patient course.
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Affiliation(s)
- A Canabal
- Servicio de Medicina Intensiva, Hospital Virgen de la Salud de Toledo, España.
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Dvorak P, Novak M, Kamaryt P, Slana B, Lipoldova J, Dvorak P. Histological findings around electrodes in pacemaker and implantable cardioverter-defibrillator patients: comparison of steroid-eluting and non-steroid-eluting electrodes. Europace 2011; 14:117-23. [DOI: 10.1093/europace/eur274] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cano O, Osca J, Sancho-Tello MJ, Olagüe J, Castro JE, Salvador A. Failure of the active-fixation mechanism during removal of active-fixation pacing leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 34:1217-24. [PMID: 21671955 DOI: 10.1111/j.1540-8159.2011.03153.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Active-fixation pacing leads are being widely employed due to their theoretical advantages when compared with traditional passive-fixation leads: easy fixation and reposition, possible deployment in alternative pacing sites, lower rates of dislodgment, and chronic removability. However, the behavior of the active-fixation mechanism during lead removal has not been yet systematically studied and may have important clinical implications. OBJECTIVE To evaluate if the active-fixation mechanism was still working properly in pacing leads that were removed due to different causes. METHODS Thirty-one consecutive patients undergoing active-fixation lead removal (40 leads) were studied. Before lead removal, the helix was retracted using the appropriate tool, and fluoroscopy signs were evaluated. After removal, the helix status was examined, and the active-fixation mechanism was once again retested when possible. RESULTS In nine of 40 leads (22.5%), the helix remained extended after lead removal in spite of having applied the number of rotations recommended by the manufacturer with the clip-on tool. There was no linear relationship between lead longevity and the presence of an extended helix after lead removal. However, failure of the active-fixation mechanism was more frequent among leads implanted <1 year before versus >1 year before (OR 6.8, 95% CI 1.1-42.7, P = 0.043). In 38% of patients with failure of the active-fixation mechanism, a previous lead reposition had been attempted before lead removal due to significant pacing threshold rise. CONCLUSIONS In our series, the active-fixation mechanism failed in up to 22.5% of explanted leads. This may have important clinical implications during active-fixation lead removal and reposition.
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Affiliation(s)
- Oscar Cano
- Electrophysiology Section, Cardiology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
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Rosso R, Medi C, Teh AW, Hung TT, Feldman A, Lee G, Mond HG. Right ventricular septal pacing: a comparative study of outflow tract and mid ventricular sites. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 33:1169-73. [PMID: 20636311 DOI: 10.1111/j.1540-8159.2010.02836.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prolonged right ventricle (RV) apical pacing is associated with left ventricle (LV) dysfunction due to dysynchronous ventricular activation and contraction. Alternative RV pacing sites with a narrower QRS compared to RV pacing might reflect a more physiological and synchronous LV activation. The purpose of this study was to compare the QRS morphology, duration, and suitability of RV outflow tract (RVOT) septal and mid-RV septal pacing. METHODS Seventeen consecutive patients with indication for dual-chamber pacing were enrolled in the study. Two standard 58-cm active fixation leads were passed to the RV and positioned in the RVOT septum and mid-RV septum using a commercially available septal stylet (model 4140, St. Jude Medical, St. Paul, MN, USA). QRS duration, morphology, and pacing parameters were compared at the two sites. The RV lead with less-satisfactory electrical parameters was withdrawn and deployed in the right atrium. RESULTS Successful positioning of the pacing leads at the RVOT septum and mid-RV septum was achieved in 15 patients (88.2%). There were no significant differences in the mean stimulation threshold, R-wave sensing, and lead impedance between the two sites. The QRS duration in the RVOT septum was 151 ± 14 ms and in the mid-RV septum 145 ± 13 ms (P = 0.150). CONCLUSIONS This prospective observational study shows that septal pacing can be reliably achieved both in the RVOT and mid-RV with active fixation leads using a specifically shaped stylet. There are no preferences in regard to acute lead performance or paced QRS duration with either position.
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Affiliation(s)
- Raphael Rosso
- Department of Cardiology, Royal Melbourne Hospital, Victoria 3050, Melbourne, Australia
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MOND HARRYG. The Road to Right Ventricular Septal Pacing: Techniques and Tools. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:888-98. [DOI: 10.1111/j.1540-8159.2010.02777.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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ROSSO RAPHAEL, TEH ANDREWW, MEDI CAROLINE, HUNG THUYTO, BALASUBRAMANIAM RICHARD, MOND HARRYG. Right Ventricular Septal Pacing: The Success of Stylet-Driven Active-Fixation Leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:49-53. [DOI: 10.1111/j.1540-8159.2009.02580.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Sekita G, Nakazato Y, Hayashi H, Hirano K, Sugihara M, Yamase M, Komatsu K, Suzuki T, Kawano Y, Tokano T, Sumiyoshi M, Daida H. Rapid Improvement and Long-term Stability of Pacing Threshold with Active-fixation Screw-in Lead. J Arrhythm 2010. [DOI: 10.1016/s1880-4276(10)80023-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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MEDI CAROLINE, MOND HARRYG. Right Ventricular Outflow Tract Septal Pacing: Long-Term Follow-Up of Ventricular Lead Performance. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:172-6. [DOI: 10.1111/j.1540-8159.2008.02199.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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REDFEARN DAMIANP, GULA LORNEJ, KRAHN ANDREWD, SKANES ALLANC, KLEIN GEORGEJ, YEE RAYMOND. Current of Injury Predicts Acute Performance of Catheter-Delivered Active Fixation Pacing Leads. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1438-44. [DOI: 10.1111/j.1540-8159.2007.00889.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Hillock RJ, Stevenson IH, Mond HG. The Right Ventricular Outflow Tract: A Comparative Study of Septal, Anterior Wall, and Free Wall Pacing. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:942-7. [PMID: 17669075 DOI: 10.1111/j.1540-8159.2007.00790.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is marked heterogeneity in right ventricular outflow tract (RVOT) pacemaker lead placement using conventional leads. As a result, we have sought to identify a reproducible way of placing a ventricular lead onto the RVOT septum. METHODS AND RESULTS A major determinant is the shape of the stylet used to deliver the active-fixation lead. We compared stylet shapes and configurations in patients who initially had a ventricular lead placed onto the anterior or free wall of the RVOT and then had the lead repositioned onto the septum. All leads were loaded with a stylet fashioned with a distal primary curve to facilitate delivery of the lead to the pulmonary artery, then using a pullback technique the lead was retracted to the RVOT. All lead placements were confirmed by fluoroscopy and electrocardiography. Anterior or free wall placement was achieved by the stylet having either the standard curve or an added distal anterior angulation. In contrast, septal lead positioning was uniformly achieved by a distal posterior angulation of the curved stylet. This difference in tip shape was highly predictive for septal placement (P < 0.001). With septal pacing, a narrower QRS duration was noted, compared to anterior or free wall pacing (136 vs 155 ms, P < 0.001). All pacing parameters were within acceptable limits. CONCLUSION Using appropriately shaped stylets, pacing leads can now be placed into specific positions within the RVOT and in particular septal pacing can be reliably and reproducibly achieved. This is an important step in the standardization of lead placement in the RVOT.
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Affiliation(s)
- Richard J Hillock
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
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Burri H, Sunthorn H, Dorsaz PA, Viera I, Shah D. Thresholds and Complications with Right Ventricular Septal Pacing Compared to Apical Pacing. Pacing Clin Electrophysiol 2007; 30 Suppl 1:S75-8. [PMID: 17302723 DOI: 10.1111/j.1540-8159.2007.00610.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Right ventricular septal pacing has been proposed as an alternative to apical pacing. However, data concerning thresholds and requirement for lead repositioning with this technique are scant. METHODS We reviewed data at implantation and follow-up of 362 consecutive recipients of the same model of active fixation lead (Medtronic 5076-58, Minneapolis, MN, USA) to avoid differences due to lead characteristics. Patients were divided into two groups according to whether the lead was positioned on the interventricular septum (n = 157) or at the right ventricular apex (n = 205). Thresholds, lead impedance, and requirement for lead repositioning were compared between groups at implantation and follow-up. RESULTS There were no differences between the septal and apical groups in sensing and pacing thresholds or lead impedance, either at implantation or during a 24-month follow-up. In the septal group, the lead had to be repositioned in four patients (2.5%) due to lead dislodgement in two patients, acute threshold rise in one patient, and pericardial effusion in another patient (the lead had unintentionally been positioned on the anterior free wall in these last two patients). In the apical group, the lead had to be repositioned in eight patients (3.9%, P = 0.56) due to lead dislodgement in three patients and acute threshold rise in five patients. CONCLUSIONS Acute and chronic thresholds associated with septal pacing are similar to those observed with apical pacing, and risk of lead dislodgement is low. However, multiple radioscopic views must be used to avoid inadvertent positioning of the lead on the anterior free wall.
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Affiliation(s)
- Haran Burri
- Cardiology Service, University Hospitals of Geneva, Geneva, Switzerland.
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Kistler PM, Liew G, Mond HG. Long-Term Performance of Active-Fixation Pacing Leads: A Prospective Study. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2006; 29:226-30. [PMID: 16606388 DOI: 10.1111/j.1540-8159.2006.00327.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Despite the increasingly widespread use of active-fixation leads, long-term clinical follow-up of pacing lead outcomes is lacking. The aim was to analyze pacing parameters over a 2-year follow-up. We performed a prospective observational study of consecutive new pacemaker implants using the 1488T St. Jude (100) and the Medtronic 5076 (100) active-fixation leads. Detailed analysis of pacing parameters was collected at implant, day 1, and 1, 3, 6, 12, 18, and 24 months. METHODS AND RESULTS One hundred patients underwent implantation of 100 dual-chamber pacemakers. Initial pacing parameters in the ventricle were threshold 0.7 +/- 0.2 V, R wave 12.0 +/- 6.5 mV, and impedance 879 +/- 224 Omega. Threshold increased significantly from day 1 (0.7 +/- 0.2 V) to month 1 (0.9 +/- 0.6 V, P < 0.01) and remained stable over the long term. Four of the 100 patients had a threshold >2 V (mean 3.3 +/- 0.9 V) all between day 1 and month 3. For all patients, R wave remained stable, but impedance declined significantly from day 1 (879 +/- 184 Omega) to month 1 (677 +/- 122 Omega, P < 0.01). There were no ventricular lead complications. Initial pacing parameters in the atrium were threshold 0.9 +/- 0.3 V, P wave 3.3 +/- 2.4 mV, and impedance 606 +/- 144 Omega. Threshold remained stable over the long-term follow-up. One of 100 patients had a rise in threshold >2 V (2.2 V) between day 1 and month 1. No patients underwent lead repositioning. Sensing and impedance remained stable over the long term. Patient follow-up was completed in 94% (6 unrelated deaths). There was an 8% incidence of atrial fibrillation. CONCLUSION Active-fixation leads are generally associated with stable long-term pacing parameters.
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Affiliation(s)
- Peter M Kistler
- Department of Cardiology, The Royal Melbourne Hospital, Parkville, Victoria, 3050, Australia
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