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Frazer M, Phan F, Przybylowicz R, Krebsbach A, Dornblaser J, Jessel PM, Bhamidipati C, Tibayan FA, Henrikson CA. Impact of fixation mechanism and helix retraction status on right ventricular lead extraction. Heart Rhythm O2 2023; 4:757-764. [PMID: 38204460 PMCID: PMC10774662 DOI: 10.1016/j.hroo.2023.11.007] [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] [Indexed: 01/12/2024] Open
Abstract
Background The impact of lead fixation mechanism on extractability is poorly characterized. Objective We aimed to compare the technical difficulty of transvenous lead extraction (TLE) of active vs passive fixation right ventricular (RV) leads. Methods A total of 408 patients who underwent RV TLE by a single expert electrophysiologist at Oregon Health & Science University between October 2011 and June 2022 were identified and retrospectively analyzed; 331 (81%) had active fixation RV leads and 77 (19%) had passive fixation RV leads. The active fixation cohort was further stratified into those with successfully retracted helices (n = 181) and failed helix retraction (n = 109). A numerical system (0-9) devised using 6 procedural criteria quantified a technical extraction score (TES) for each RV TLE. The TES was compared between groups. Results Helix retraction was successful in ≥55% of active fixation TLEs. The mean TES for active-helix retracted, active-helix non-retracted, and passive fixation groups was 1.8, 3.5, and 3.7, respectively. The TES of the active-helix retracted group was significantly lower than those of the active-helix non-retracted group (adjusted P < .01) and the passive fixation group (adjusted P < .01). There was no significant difference in TES between the passive fixation and active-helix non-retracted groups in multivariate analysis (P = .18). The TLE success rate of the entire cohort was >97%, with a major complication rate of 0.5%. Conclusion TLE of active fixation leads where helical retraction is achieved presents fewer technical challenges than does passive fixation RV lead extraction; however, if the helix cannot be retracted, active and passive TLE procedures present similar technical challenges.
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Affiliation(s)
| | - Francis Phan
- Oregon Health & Science University, Portland, Oregon
| | | | | | | | - Peter M. Jessel
- Oregon Health & Science University, Portland, Oregon
- VA Portland Health Care System, Portland, Oregon
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Knops RE, Reddy VY, Ip JE, Doshi R, Exner DV, Defaye P, Canby R, Bongiorni MG, Shoda M, Hindricks G, Neužil P, Rashtian M, Breeman KTN, Nevo JR, Ganz L, Hubbard C, Cantillon DJ. A Dual-Chamber Leadless Pacemaker. N Engl J Med 2023; 388:2360-2370. [PMID: 37212442 DOI: 10.1056/nejmoa2300080] [Citation(s) in RCA: 59] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Single-chamber ventricular leadless pacemakers do not support atrial pacing or consistent atrioventricular synchrony. A dual-chamber leadless pacemaker system consisting of two devices implanted percutaneously, one in the right atrium and one in the right ventricle, would make leadless pacemaker therapy a treatment option for a wider range of indications. METHODS We conducted a prospective, multicenter, single-group study to evaluate the safety and performance of a dual-chamber leadless pacemaker system. Patients with a conventional indication for dual-chamber pacing were eligible for participation. The primary safety end point was freedom from complications (i.e., device- or procedure-related serious adverse events) at 90 days. The first primary performance end point was a combination of adequate atrial capture threshold and sensing amplitude at 3 months. The second primary performance end point was at least 70% atrioventricular synchrony at 3 months while the patient was sitting. RESULTS Among the 300 patients enrolled, 190 (63.3%) had sinus-node dysfunction and 100 (33.3%) had atrioventricular block as the primary pacing indication. The implantation procedure was successful (i.e., two functioning leadless pacemakers were implanted and had established implant-to-implant communication) in 295 patients (98.3%). A total of 35 device- or procedure-related serious adverse events occurred in 29 patients. The primary safety end point was met in 271 patients (90.3%; 95% confidence interval [CI], 87.0 to 93.7), which exceeded the performance goal of 78% (P<0.001). The first primary performance end point was met in 90.2% of the patients (95% CI, 86.8 to 93.6), which exceeded the performance goal of 82.5% (P<0.001). The mean (±SD) atrial capture threshold was 0.82±0.70 V, and the mean P-wave amplitude was 3.58±1.88 mV. Of the 21 patients (7%) with a P-wave amplitude of less than 1.0 mV, none required device revision for inadequate sensing. At least 70% atrioventricular synchrony was achieved in 97.3% of the patients (95% CI, 95.4 to 99.3), which exceeded the performance goal of 83% (P<0.001). CONCLUSIONS The dual-chamber leadless pacemaker system met the primary safety end point and provided atrial pacing and reliable atrioventricular synchrony for 3 months after implantation. (Funded by Abbott Medical; Aveir DR i2i ClinicalTrials.gov number, NCT05252702.).
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Affiliation(s)
- Reinoud E Knops
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Vivek Y Reddy
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - James E Ip
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Rahul Doshi
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Derek V Exner
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Pascal Defaye
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Robert Canby
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Maria Grazia Bongiorni
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Morio Shoda
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Gerhard Hindricks
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Petr Neužil
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Mayer Rashtian
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Karel T N Breeman
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Jordan R Nevo
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Leonard Ganz
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Chris Hubbard
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
| | - Daniel J Cantillon
- From Amsterdam University Medical Centers, Amsterdam (R.E.K., K.T.N.B.); Icahn School of Medicine at Mount Sinai (V.Y.R.) and Weill Cornell Medicine-New York Presbyterian Hospital (J.E.I.) - both in New York; HonorHealth Cardiac Arrhythmia Group, Scottsdale, AZ (R.D.); Foothills Medical Centre, Calgary, AB, Canada (D.V.E.); Centre Hospitalier Régional Universitaire Albert Michallon, Grenoble, France (P.D.); Texas Cardiac Arrhythmia Institute, Austin (R.C.); Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy (M.G.B.); Tokyo Women's Medical University, Tokyo (M.S.); Deutsches Herzzentrum der Charité, Berlin (G.H.); Na Homolce Hospital, Prague, Czech Republic (V.Y.R., P.N.); Huntington Memorial Hospital, Pasadena (M.R.), and Abbott Medical, Sylmar (J.R.N., L.G., C.H.) - both in California; and the Cleveland Clinic, Cleveland (D.J.C.)
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Breeman KTN, Oosterwerff EFJ, de Graaf MA, Juffer A, Saleem-Talib S, Maass AH, Wilde AAM, Boersma LVA, Ramanna H, van Dijk VF, van Erven L, Delnoy PPHM, Tjong FVY, Knops RE. Five-year safety and efficacy of leadless pacemakers in a Dutch cohort. Heart Rhythm 2023:S1547-5271(23)02322-6. [PMID: 37271354 DOI: 10.1016/j.hrthm.2023.05.031] [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: 04/07/2023] [Revised: 05/16/2023] [Accepted: 05/26/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Adequate real-world safety and efficacy of leadless pacemakers (LPs) has been demonstrated up to three years after implantation. Longer-term data is warranted to assess the net clinical benefit of leadless pacing. OBJECTIVE To evaluate the long-term safety and efficacy of LP therapy in a real-world cohort. METHODS In this retrospective cohort study, all consecutive patients were included with a first LP implantation from December 21, 2012 to December 13, 2016 in six Dutch high-volume centers. The primary safety endpoint was the rate of major procedure- or device-related complications (i.e., requiring surgery) at five-year follow-up. Analyses were performed with and without Nanostim battery advisory-related complications. The primary efficacy endpoint was the percentage of patients with a pacing capture threshold of ≤2.0V at implantation and without ≥1.5V increase at the last follow-up visit. RESULTS 179 patients were included (mean age 79±9 years), 93 (52%) with a Nanostim and 86 (48%) with a Micra VR LP. Mean follow-up duration was 44±26 months. Forty-one major complications occurred, of which seven not advisory-related. The five-year major complication rate was 4% without advisory-related complications and 27% including advisory-related complications. Not advisory-related major complications occurred median 10 days (range 0-88 days) post-implantation. The pacing capture threshold was low in 163/167 (98%) and stable in 157/160 (98%). CONCLUSION The long-term major complication rate without advisory-related complications was low with LPs. No complications occurred after the acute phase and no infections occurred, which may be a specific benefit of LPs. The performance was adequate with a stable pacing capture threshold.
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Affiliation(s)
- Karel T N Breeman
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands.
| | - Erik F J Oosterwerff
- Isala Clinics, Department of Cardiology, Zwolle, The Netherlands; Flevo Hospital, Department of Cardiology, Almere, The Netherlands
| | - Michiel A de Graaf
- Leiden University Medical Center, Department of Cardiology, Leiden, The Netherlands
| | - Albert Juffer
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | | | - Alexander H Maass
- University Medical Center Groningen, Department of Cardiology, Groningen, Netherlands
| | - Arthur A M Wilde
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Lucas V A Boersma
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands; St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | - Hemanth Ramanna
- Haga Teaching Hospital, Department of Cardiology, the Hague, The Netherlands
| | - Vincent F van Dijk
- St. Antonius Hospital, Department of Cardiology, Nieuwegein, the Netherlands
| | - Lieselot van Erven
- Leiden University Medical Center, Department of Cardiology, Leiden, The Netherlands
| | | | - Fleur V Y Tjong
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
| | - Reinoud E Knops
- Amsterdam UMC location AMC, Department of Cardiology, Amsterdam, The Netherlands, Amsterdam Cardiovascular Sciences, Heart failure & arrhythmias, Amsterdam, The Netherlands
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4
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Stritecky J, Kremlacek J, Hanus J, Haman L, Stritecka H, Simka J, Parizek P. Capture threshold of bipolar and unipolar pacing of left ventricle via coronary sinus branch: longitudinal study. Front Cardiovasc Med 2023; 10:1096538. [PMID: 37288262 PMCID: PMC10242161 DOI: 10.3389/fcvm.2023.1096538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 04/18/2023] [Indexed: 06/09/2023] Open
Abstract
Introduction The aim of this paper is to first monitor the changes in the capture threshold of endovascularly placed leads for left ventricle pacing, second to compare the pacing configurations, and third to verify the effect of Steroid elution for endovascular leads. Sample and Method The study included 202 consecutive single centre patients implanted with the Quartet™ lead (St. Jude Medical). The capture threshold and related lead parameters were tested during implantation, on the day of the patient's discharge, and 3, 9, and 15 months after implantation. The electrical energy corresponding to the threshold values for inducing ventricular contraction was recorded for subgroups of patients with bipolar and pseudo-unipolar pacing vectors and electrodes equipped with and without a slow-eluting steroids. The best setting for the resynchronization effect was generally chosen. Capture threshold was taken as a selection criterion only if there were multiple options with (expected) similar resynchronization effect. Results and Discussion The measurements showed that the ratio of threshold energies of UNI vs. BI was 5× higher (p < 0.001) at implantation. At the end of the follow-up, it dropped to 2.6 (p = 0.012). The steroid effect in BI vectors was caused by a double capture threshold in the NSE group compared to the SE group (p < 0.001), increased by approximately 2.5 times (p < 0.001). The study concludes that after a larger initial increase in the capture threshold, the leads showed a gradual increase in the entire set. As a result, the bipolar threshold energies increase, and the pseudo-unipolar energies decrease. Since bipolar vectors require a significantly lower pacing energy, battery life of the implanted device would improve. When evaluating the steroid elution of bipolar vectors, we observe a significant positive effect of a gradual increase of the threshold energy.
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Affiliation(s)
- Jakub Stritecky
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Králové, Czech Republic
- 1st Department of Internal Medicine – Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Jan Kremlacek
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Králové, Czech Republic
| | - Josef Hanus
- Department of Medical Biophysics, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Králové, Czech Republic
| | - Ludek Haman
- 1st Department of Internal Medicine – Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Hana Stritecka
- Department of Military Internal Medicine and Military Hygiene, Faculty of Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - Jakub Simka
- 1st Department of Internal Medicine – Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
| | - Petr Parizek
- 1st Department of Internal Medicine – Cardioangiology, University Hospital Hradec Kralove, Hradec Kralove, Czech Republic
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Luo J, Zhou Z, Chen K, Lin J, Cai C, Zeng Z. Implantation of a dual-chamber pacemaker in a patient with dextrocardia and sick sinus syndrome: a case report. J Int Med Res 2022; 50:3000605221088551. [PMID: 35345937 PMCID: PMC8969507 DOI: 10.1177/03000605221088551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 02/28/2022] [Indexed: 11/15/2022] Open
Abstract
Dextrocardia is a congenital abnormal position of the heart in which the main part of the heart is in the right chest, and the long axis of the heart points to the lower right. Cases of a combination of dextrocardia and sick sinus syndrome are rare. A 65-year-old female patient was admitted to hospital with palpitations and dizziness for 1 week. Mirror-image dextrocardia and sick sinus syndrome were diagnosed by an electrocardiogram, echocardiography, Holter monitoring, and X-rays. Finally, we successfully implanted a dual-chamber pacemaker into the patient. The patient had an uneventful recovery and was discharged when her symptoms had greatly improved 1 week later. When dextrocardia is present, using active fixation leads in the atrial and ventricular leads is easier for finding the pacing position with optimal sensing and pacing thresholds, and they reduce the incidence of falling off.
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Affiliation(s)
- Junqian Luo
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong Province, China
| | - Zihao Zhou
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong Province, China
| | - Kaicong Chen
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong Province, China
| | - Junyao Lin
- The Second People’s Hospital of Shanwei (Yihui Fund Hospital of Shanwei), Shanwei, Guangdong Province, 516600 China
| | - Chaogeng Cai
- The Second People’s Hospital of Shanwei (Yihui Fund Hospital of Shanwei), Shanwei, Guangdong Province, 516600 China
| | - Zhihuan Zeng
- The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou 510080, Guangdong Province, China
- Zhihuan Zeng, The First Affiliated Hospital of Guangdong Pharmaceutical University, No. 19 Nonglinxia Road, Guangzhou, Guangdong 510080, People’s Republic of China.
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Breeman KTN, Swackhamer B, Brisben AJ, Quast AFBE, Carter N, Shuros A, Soltis B, Koop BE, Burke MC, Wilde AAM, Tjong FVY, Knops RE. Long-term Performance of Novel Communicating Antitachycardia-Enabled Leadless Pacemaker and Subcutaneous Implantable Cardioverter-Defibrillator System: a Comprehensive Preclinical Study. Heart Rhythm 2022; 19:837-846. [DOI: 10.1016/j.hrthm.2022.01.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/07/2022] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
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Electrical abnormalities with St. Jude/Abbott pacing leads: A systematic review and meta-analysis. Heart Rhythm 2021; 18:2061-2069. [PMID: 34461304 DOI: 10.1016/j.hrthm.2021.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Although there is a paucity of contemporary data on pacemaker lead survival rates, small studies suggest that some leads may have higher malfunction rates than do others. OBJECTIVE The purpose of this study was to determine the malfunction rates of current pacemaker leads. METHODS A meta-analysis including studies that examined the non-implant-related lead malfunction rates of current commercially available active fixation pacemaker leads was performed. An electronic search of MEDLINE/PubMed, Scopus, and Embase was performed. DerSimonian and Laird random effects models were used. RESULTS Eight studies with a total of 14,579 leads were included. Abbott accounted for 10,838 (74%), Medtronic 2510 (17%), Boston Scientific 849 (6%), and MicroPort 382 (3%) leads. The weighted mean follow-up period was 3.6 years. Lead abnormalities occurred in 5.0% of all leads, 6.1% of Abbott leads, 1.1% of Medtronic, 1.4% of Boston Scientific, and 5.5% of MicroPort. The most common lead abnormality was lead noise with normal impedance. Abbott leads were associated with an increased risk of abnormalities (relative risk [RR] 7.81; 95% confidence interval [CI] 3.21-19.04), reprogramming (RR 7.95; 95% CI 3.55-17.82), and lead revision or extraction (RR 8.91; 95% CI 3.36-23.60). Abbott leads connected to an Abbott generator had the highest abnormality rate (8.0%) followed by Abbott leads connected to a non-Abbott generator (4.7%) and non-Abbott leads connected to an Abbott generator (0.4%). CONCLUSIONS Abbott leads are associated with an increased risk of abnormalities compared with leads of other manufacturers, primarily manifesting as lead noise with normal impedance, and are associated with an increased risk of lead reprogramming and lead revision or extraction.
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8
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Incidence, patterns, and outcomes after transvenous cardiac device lead macrodislodgment: Insights from a population-based study. Heart Rhythm 2019; 16:140-147. [DOI: 10.1016/j.hrthm.2018.07.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Indexed: 11/20/2022]
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9
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Peng H, Sun Z, Zhang H, Ma W. Long-term performance of right ventricular pacing leads: risk factors associated with permanent right ventricular pacing threshold increase. J Interv Card Electrophysiol 2018; 55:349-357. [PMID: 30402790 PMCID: PMC6694072 DOI: 10.1007/s10840-018-0481-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022]
Abstract
Purpose Right ventricular pacing threshold (RVPT) may rise over time accompanied by the increased use of implantable cardiac pacemakers. However, risk factors for permanent RVPT increase are not fully clarified in patients without definite lead fracture and dislodgment. We aimed to evaluate the long-term performance of RV pacing leads and identify risk factors associated with the occurrence of permanent RVPT increase in this population. Methods Patients with first implantation of cardiac pacemakers from January 2008 to June 2016 were consecutively enrolled. Follow-up for RVPT increase was until December 2017. The clinical data, specific data on the pacemaker implantation, and routine follow-up were retrieved. Results During a follow-up duration of 5.4 ± 2.1 years, permanent RVPT increase (except lead fracture and dislodgment) was found in 8.4% (87/1033) patients. Patients with permanent RVPT increase had higher prevalence of myocardial infarction (MI), diabetes, and the use of amiodarone. The risk factors independently associated with permanent RVPT increase were MI (HR = 1.094, 95% CI 1.014–1.180, p = 0.031), diabetes (HR = 2.804, 95% CI 1.064–3.775, p = 0.003). MI patients with RVPT increase had higher prevalence of multivessel disease and atrioventricular block. Diabetic patients with RVPT increase exhibited higher serum fasting blood glucose (FBG) and hemoglobin A1c (HbA1c) levels, which were correlated with the maximum RVPT (p < 0.001). Conclusions Our data showed that permanent RVPT increases (except lead fracture and dislodgement) during long-term follow-up after pacemaker implantation. The likely risk factors predisposing to chronic permanent RVPT increase are MI and diabetes with higher FBG and HbA1c levels.
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Affiliation(s)
- Hui Peng
- Section of Electrophysiology, Division of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95 Yongan Road, Xi-cheng District, Beijing, 100050, China.
| | - Zhijun Sun
- Section of Electrophysiology, Division of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95 Yongan Road, Xi-cheng District, Beijing, 100050, China
| | - Heping Zhang
- Section of Electrophysiology, Division of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95 Yongan Road, Xi-cheng District, Beijing, 100050, China
| | - Wenying Ma
- Section of Electrophysiology, Division of Cardiology, Beijing Friendship Hospital Affiliated to Capital Medical University, No. 95 Yongan Road, Xi-cheng District, Beijing, 100050, China
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10
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Could persistency of current of injury forecast successful active-fixation pacing lead implantation? Int J Cardiol 2018; 258:121-125. [DOI: 10.1016/j.ijcard.2018.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/13/2017] [Accepted: 01/02/2018] [Indexed: 11/23/2022]
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11
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Tjong FV, Brouwer TF, Koop B, Soltis B, Shuros A, Schmidt B, Swackhamer B, Quast AFE, Wilde AA, Burke MC, Knops RE. Acute and 3-Month Performance of a Communicating Leadless Antitachycardia Pacemaker and Subcutaneous Implantable Defibrillator. JACC Clin Electrophysiol 2017; 3:1487-1498. [DOI: 10.1016/j.jacep.2017.04.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/24/2017] [Accepted: 04/26/2017] [Indexed: 10/19/2022]
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12
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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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13
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Zhou L, Bar-Cohen Y, Peck RA, Chirikian GV, Harwin B, Chmait RH, Pruetz JD, Silka MJ, Loeb GE. Analytical Modeling for Computing Lead Stress in a Novel Epicardial Micropacemaker. Cardiovasc Eng Technol 2017; 8:96-105. [PMID: 28070867 DOI: 10.1007/s13239-017-0292-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 01/02/2017] [Indexed: 12/01/2022]
Abstract
Implantation and maintenance of a permanent cardiac pacing system in children remains challenging due to small patient size, congenital heart defects and somatic growth. We are developing a novel epicardial micropacemaker for children that can be implanted on the epicardium within the pericardial space via a minimally-invasive technique. The key design configurations include a novel open-coiled lead in which living tissue replaces the usual polymeric support for the coiled conductor. To better understand and be able to predict the behavior of the implanted lead, we performed a radiographic image-based modeling study on a chronic animal test. We report a pilot study in which two mechanical dummy pacemakers with epicardial leads were implanted into an adult pig model via a minimally invasive approach. Fluoroscopy was obtained on the animal on Post-Operative Days #9, #35 and #56 (necropsy). We then constructed an analytic model to estimate the in vivo stress conditions on the open-coil lead based on the analysis of orthogonal biplane radiographic images. We obtained geometric deformation data of the implanted lead including elongation magnitudes and bending radii from sequenced films of cardiac motion cycles. The lead stress distribution was investigated on each film frame and the point of maximum stress (Mean Stress = 531.4 MPa; Alternating Stress = ± 216.4 MPa) was consistently where one of the leads exited the pericardial space, a deployment that we expected to be unfavorable. These results suggest the modeling approach can provide a basis for further design optimization. More animal tests and modeling will be needed to validate whether the novel lead design could meet the requirements to withstand ~200 million cardiac motion cycles over 5 years.
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Affiliation(s)
- Li Zhou
- Medical Device Development Facility, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA.
| | - Yaniv Bar-Cohen
- Division of Cardiology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Raymond A Peck
- Medical Device Development Facility, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
| | - Giorgio V Chirikian
- Medical Device Development Facility, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
| | - Brett Harwin
- Medical Device Development Facility, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
| | - Ramen H Chmait
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1300 North Vermont Avenue, Suite 710, Los Angeles, CA, 90027, USA
| | - Jay D Pruetz
- Division of Cardiology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Keck School of Medicine, University of Southern California, 1300 North Vermont Avenue, Suite 710, Los Angeles, CA, 90027, USA
| | - Michael J Silka
- Division of Cardiology, Department of Pediatrics, Keck School of Medicine, Children's Hospital Los Angeles, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA, 90027, USA
| | - Gerald E Loeb
- Medical Device Development Facility, Department of Biomedical Engineering, Viterbi School of Engineering, University of Southern California, 1042 Downey Way, Los Angeles, CA, 90089, USA
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Takano A, Sekita G, Watanabe M, Mukaida H, Komatsu S, Tabuchi H, Hayashi H, Tokano T, Sumiyoshi M, Nakazato Y, Daida H. Long-term reliability of sweet-tip type screw-in leads. J Arrhythm 2016; 33:12-16. [PMID: 28217223 PMCID: PMC5300837 DOI: 10.1016/j.joa.2016.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 04/07/2016] [Accepted: 04/25/2016] [Indexed: 11/26/2022] Open
Abstract
Background Active fixation leads have provided stable atrial and ventricular pacing; however, long-term follow-up data have not been satisfactory. The purpose of this study was to investigate the long-term reliability of active fixation leads and their electrical characteristic stability. Methods A total of 1196 pacing leads were implanted in 830 patients consecutively between 2002 and 2013. In this retrospective study, we were able to trace 1092 leads in 750 patients to investigate the prognosis of implanted leads. The measurement values (including pacing thresholds, sensing amplitudes, and lead impedances of both the atrial and ventricular leads) were obtained from medical records at the time of implantation and during follow up at the outpatient device clinic. All pacing leads were FINELINE II Sterox EZ Leads (Boston Scientific, MN, USA), which are sweet-tip type screw-in active fixation leads, except for the shock leads in patients with implantable cardioverter defibrillator. Results The mean follow-up period was 51.3±29.2 months (median, 48 months). A total of 1092 leads were implanted in either the atrium (682 leads) or the ventricle (410 leads). Venous access was achieved through cephalic vein cut down (CVC) method (914 leads) or the subclavian vein puncture (SVP) method (178 leads). The overall lead survival rate was 99.6% at both 5 and 10 years. Lead fracture was observed in 4 of 1092 leads (0.37%), all of which were implanted by the SVP method. No lead fracture occurred among patients wherein CVC method was applied (p<0.01). Device-related infection was observed in four patients (0.53%). Conclusions The overall reliability and stability of sweet-tip type screw-in leads were satisfactory throughout the long-term follow-up period (median, 4 years). Because it was associated with less lead fractures, cut-down access from the cephalic vein may be recommended as the first-line approach when considering the importance of long-term durability of pacing leads.
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Affiliation(s)
- Asuka Takano
- Graduate School of Medicine, Juntendo University, Tokyo, Japan; Department of Clinical Engineering, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Gaku Sekita
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Minako Watanabe
- Department of Clinical Engineering, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Hiroshi Mukaida
- Graduate School of Medicine, Juntendo University, Tokyo, Japan; Department of Clinical Engineering, Juntendo University Hospital, 3-1-3 Hongo, Bunkyo-ku, Tokyo 113-8431, Japan
| | - Sayaka Komatsu
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Haruna Tabuchi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hidemori Hayashi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takashi Tokano
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Masataka Sumiyoshi
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Yuji Nakazato
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine, Tokyo, Japan
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Biffi M, Bertini M, Saporito D, Belotti G, Quartieri F, Piancastelli M, Pucci A, Boggian G, Mazzocca GF, Giorgi D, Diotallevi P, Diemberger I, Martignani C, Pancaldi S, Ziacchi M, Marcantoni L, Toselli T, Attala S, Iori M, Bottoni N, Argnani S, Tomasi C, Sassone B, Boriani G. Automatic management of atrial and ventricular stimulation in a contemporary unselected population of pacemaker recipients: the ESSENTIAL Registry. Europace 2016; 18:1551-1560. [DOI: 10.1093/europace/euw021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/20/2016] [Indexed: 11/14/2022] Open
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Right ventricular outflow tract septal pacing versus apical pacing: A prospective, randomized, single-blind 5-years follow-up study of ventricular lead performance and safety. ACTA ACUST UNITED AC 2015; 35:858-861. [DOI: 10.1007/s11596-015-1518-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 10/29/2015] [Indexed: 10/22/2022]
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17
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Keilegavlen H, Hovstad T, Færestrand S. Active fixation of a thin transvenous left-ventricular lead by a side helix facilitates targeted and stable placement in cardiac resynchronization therapy. Europace 2015; 18:1235-40. [PMID: 26443447 DOI: 10.1093/europace/euv272] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/15/2015] [Indexed: 11/12/2022] Open
Abstract
AIMS Suboptimal placement, phrenic nerve stimulation, and dislodgements of left-ventricular (LV) leads are main challenges in cardiac resynchronization therapy. We investigated the handling, performance, safety, and stability for a novel 4Fr LV lead with a small side helix located proximal to the ring electrode for active fixation of the LV lead. METHODS AND RESULTS The novel LV lead was successfully implanted in 103 of 106 patients. Patients with dislodged LV leads and with demanding coronary vein anatomies were included. The lead body was rotated clockwise to engage the active fixation side helix in the vein wall. The stimulating electrode was located in basal LV segment and middle LV segment in 54 and 46% of the patients, respectively. The lead was targeted to a vein concordant to the LV segment with latest mechanical activation. Concordant LV lead placement was achieved in 73% of the patients and in adjacent segment in 24%. The average pacing capture threshold (PCT) at implantation was 1.04 ± 0.6 V (n = 103) and at an average follow-up at 7 months, the PCT remained low and no dislodgements have been observed. During follow-up, four leads have been explanted without complications. CONCLUSION Active fixation of this 4Fr LV lead by using a side helix, offers flexibility to place the lead precisely in targeted vein segments over a wide range of vein anatomies. The average LV pacing threshold was low at implantation and follow-ups. The lead seems to be extractable and no late dislodgements have been observed.
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Affiliation(s)
- Håvard Keilegavlen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Thomas Hovstad
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Svein Færestrand
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway Department of Clinical Science, University of Bergen, Bergen, Norway
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Tang G, Zhai C, Wang Z, Chen H. Permanent pacemaker implanted into patient's left ventricle via subclavian artery by mistake: a case report. BMC Cardiovasc Disord 2015; 15:39. [PMID: 25964130 PMCID: PMC4429375 DOI: 10.1186/s12872-015-0032-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 04/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although various iatrogenic complications could be observed in the process of permanent pacemaker implantation, pacemaker electrode mistakenly implanted into left ventricle via subclavian artery and aortic valve has not been reported. CASE PRESENTATION Herein, we reported a 71-year-old woman with permanent pacemaker mistakenly implanted into the left ventricle. During the operation of permanent pacemaker implantation, puncture was performed on her subclavian artery by mistake, and then the pacemaker electrode was put into the cardiac apex of left ventricle via ascending aorta reversely. CONCLUSION The further operation could be conducted.
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Affiliation(s)
- Guanmin Tang
- Department of Cardiology, Jiaxing Cardiovascular Key Discipline, First Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing, Zhejiang, 314000, China.
| | - Changlin Zhai
- Department of Cardiology, Jiaxing Cardiovascular Key Discipline, First Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing, Zhejiang, 314000, China.
| | - Zhiyong Wang
- Department of Cardiology, Jiaxing Cardiovascular Key Discipline, First Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing, Zhejiang, 314000, China.
| | - Hao Chen
- Department of Cardiology, Jiaxing Cardiovascular Key Discipline, First Affiliated Hospital of Jiaxing University, No. 1882 South Zhonghuan Road, Jiaxing, Zhejiang, 314000, 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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Haghjoo M, Mollazadeh R, Aslani A, Dastmalchi J, Mashreghi-Moghadam H, Heidari-Mokarar H, Vakili-Zarch A, Alizadeh A. Prediction of midterm performance of active-fixation leads using current of injury. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 37:231-6. [PMID: 23998792 DOI: 10.1111/pace.12262] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/10/2013] [Accepted: 07/18/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are only limited prospective data on the clinical relevance of current of injury (COI) as a predictor of the midterm performance of active-fixation leads. This study sought to investigate whether it is possible to predict the midterm performance of active-fixation leads using COI recorded at the time of implantation. METHODS AND RESULTS One hundred fifty patients (78 men; mean age, 63 ± 19 years) who received active-fixation pacing (n = 201) and defibrillator (n = 51) leads were studied. COI was measured from the intracardiac bipolar electrogram recorded at the time of lead implantation. The study outcome was good lead performance at 6 months, defined as P wave ≥ 1.5 mV, threshold <1.5 V for atrial lead, R-wave ≥ 5 mV, and threshold <1 V for ventricular lead. A total of 102 active-fixation atrial and 150 ventricular leads were implanted. During a 6-month follow-up, invasive intervention was required for seven atrial and seven ventricular leads. In multivariate analysis, COI was the only independent predictor of good outcome for the active-fixation atrial (odds ratio [OR]: 5.67, 95% confidence interval [CI]: 2.18-14.76, P = 0.001) and ventricular leads (OR: 3.99, 95% CI: 1.08-21.26, P = 0.002). Receiver-operating characteristic analysis identified ST-segment elevation ≥2.0 mV for the atrial leads (sensitivity, 75%; specificity, 89%) and ≥10.0 mV for the ventricular leads (sensitivity, 70%; specificity, 87%) as optimal cutoffs for good midterm performance. CONCLUSIONS Midterm performance of active-fixation leads is predictable using COI recorded at the time of lead implantation. A ST-segment elevation ≥2.0 mV in the atrial leads and ≥10.0 mV in the ventricular leads are recommended to improve the lead performance at 6 months.
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Affiliation(s)
- Majid Haghjoo
- Cardiac Electrophysiology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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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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Silvetti MS, Drago F, Ravà L. Long-term outcome of transvenous bipolar atrial leads implanted in children and young adults with congenital heart disease. Europace 2012; 14:1002-7. [PMID: 22379180 DOI: 10.1093/europace/eus024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Atrial leads are often implanted in paediatric patients needing a pacemaker (PM). The aim of this study is the evaluation of their outcome in young patients. METHODS AND RESULTS We evaluated transvenous atrial leads outcome in children and young adults from a single centre, with a retrospective analysis. A P< 0.05 was considered significant. Between 1992 and 2008, 110 patients, 75 with congenital heart defects (d-transposition of great arteries status/post, s/p, Mustard 41%, atrioventricular septal defect 11%, tetralogy 9%, ventricular septal defect 8%), aged 13.3 ± 5.3 years, underwent PM implantation with bipolar atrial transvenous leads for sinus node dysfunction (50%), atrioventricular block (38%), cardiomyopathies, and primary ventricular arrhythmias (12%). Leads are steroid-eluting (98%), tined (59%), screw-in (41%), polyurethane-insulated (72%), silicone-insulated (28%), and have been positioned by transcutaneous puncture of subclavian vein into right atrial appendage/remnant (RAA, 50%), right atrial free wall/septum (25%), left atrium (s/p Mustard, 25%). Follow-up duration is 6.4 ± 4.8 (range 0.1-18) years. At multivariate analysis, younger age at implant was a risk factor for lead failure (4 leads, 3.5%) (P= 0.03); 16 leads (14%) dislodged post-implantation and 12 were successfully repositioned, the others extracted or abandoned. Dislocation occurred more frequently with screw-in leads (P= 0.03) positioned outside RAA (P= 0.02). Atrial threshold showed a small but significant increase, 0.002 V/month (P< 0.001), impedance showed a decrease (0.6 Ω/month, P< 0.001), P-wave showed no significant difference. CONCLUSIONS Transvenous bipolar atrial leads have good long-term results in young patients, with a very low rate of lead failure. Older age at implant can further reduce this rate. Lead dislodgement is frequent in the post-operative period.
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Affiliation(s)
- Massimo Stefano Silvetti
- Paediatric Arrhythmology Unit and Syncope Unit, Paediatric Cardiology and Heart-Surgery Department, Bambino Gesù Children's Hospital, IRCCS Rome, Italy.
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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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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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BIFFI MAURO, MARTIGNANI CRISTIAN, BORIANI GIUSEPPE. Response:. Pacing Clin Electrophysiol 2011. [DOI: 10.1111/j.1540-8159.2010.03008.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Biffi M, Bertini M, Mazzotti A, Gardini B, Mantovani V, Ziacchi M, Valzania C, Martignani C, Diemberger I, Boriani G. Long-term RV threshold behavior by automated measurements: safety is the standpoint of pacemaker longevity! PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:89-95. [PMID: 21029120 DOI: 10.1111/j.1540-8159.2010.02915.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND We studied long-term right ventricular (RV) pacing threshold (RVPT) behavior in patients consecutively implanted with pacemakers capable of automatic output reprogramming tracked by automatic RV threshold measurement (automatic verification of capture [AVC]). METHODS All the patients had state-of-the art steroid-eluting bipolar pacing leads and were RV-paced by an AVC algorithm from the three American manufacturers. Follow-up occurred twice in the first year after implantation, then yearly until approaching elective replacement indicator. RESULTS Three hundred and twenty-one patients aged 73 ± 12 years were observed for 49 ± 26 months on average. At implantation, RVPT was 0.54 ± 0.2 V at 0.4 ms at an average 774 ± 217 Ω impedance. Forty-one of the 321 patients (12.8%) had a permanent RVPT increase above 1.5 V at 0.4 ms: RVPT was between 1.6 and 2.5 V in 29 of 321 (9%) patients, whereas it was between 2.6 and 3.5 V in seven of 321 (2.2%) patients, and >3.5 V in five of 321 (1.5%) patients. No exit block occurred because of automatic RV output adjustment by AVC algorithms. No predictor of RVPT increase was found at multivariable analysis. The maximum RVPT increase occurred within 12 months from implantation in 19 of 321 (5.9%) patients, between the first and the second year in 12 of 321 (3.7%), between the second and the sixth year in eight of 321 (2.5%), and after the sixth year in two of 321 (0.6%). CONCLUSION Despite technologic improvement in lead manufacturing, long-term increase of the RVPT occurs in about 13% of patients, possibly representing a serious safety issue in 3.7% when 2.5 V at 0.4 ms is exceeded. AVC algorithms can improve patients' safety by automatic tailoring of the pacing output to threshold fluctuations, while maximizing device longevity.
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Affiliation(s)
- Mauro Biffi
- S.Orsola-Malpighi Hospital, Institute of Cardiology, University of Bologna, Bologna, Italy.
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Scott PA, Chungh A, Zeb M, Yue AM, Roberts PR, Morgan JM. Is the use of an additional pace/sense lead the optimal strategy for the avoidance of lead extraction in defibrillation lead failure? A single-centre experience. Europace 2009; 12:522-6. [DOI: 10.1093/europace/eup406] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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JOHNSON WBEN, ABRAHAM WILLIAMT, YOUNG JAMESB, WHEELAN KEVIN, SMITH ANDREWL, CHANG YANPING, BRINKMAN PAULA. Long-Term Performance of the Attain Model 4193 Left Ventricular Lead. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:1111-6. [DOI: 10.1111/j.1540-8159.2009.02451.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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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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Pericarditis induced by active-fixation lead shown by positron emission tomography/computed tomography. Heart Rhythm 2008; 5:1493-4. [DOI: 10.1016/j.hrthm.2008.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Indexed: 11/19/2022]
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Hauser RG, Hayes DL, Kallinen LM, Cannom DS, Epstein AE, Almquist AK, Song SL, Tyers GFO, Vlay SC, Irwin M. Clinical experience with pacemaker pulse generators and transvenous leads: An 8-year prospective multicenter study. Heart Rhythm 2007; 4:154-60. [PMID: 17275749 DOI: 10.1016/j.hrthm.2006.10.009] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2006] [Accepted: 10/05/2006] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pacemakers have improved the lives of patients worldwide. Unfortunately, the medical community has had little independent information regarding the performance of these vital medical devices. OBJECTIVES The purpose of this study was to examine the reasons pacemaker pulse generators and transvenous leads were removed from service. We evaluated the causes and major adverse clinical events associated with device end-of-service life behavior and how they were detected and managed. METHODS Pulse generator and lead data were entered prospectively using a web-based format. Normal battery depletion was signified by the elective replacement indicator appearing >3 years after implant. Lead failure was a device defect causing pacing, sensing, or fixation malfunction, high threshold, or abnormal impedance. Major adverse clinical events were death, angina, heart failure, syncope, and perioperative surgical complications. RESULTS From 1998 to 2006, 2,652 pulse generator and 615 leads were removed from service. The average pulse generator was implanted for 7.3 +/- 3.1 years (range <1 day to 26 years). The majority of pulse generators (n = 2,317 [87%]) were replaced for normal battery depletion. Severe and accelerated battery depletion, manufacturers' advisories, and electronic or connector defects accounted for 13% of pulse generator removals. The proportion of pulse generators removed from service as a result of manufacturers' advisories, electronic failure, and housing defects were 4%, 2%, and 1%, respectively. Models with rate response capability had shorter battery longevities than those without rate response capability. Major adverse clinical events due to pulse generator end-of-service life behavior were related to electronic and connector defects, and both normal and severe battery depletion. Median time to lead failure was 7.2 +/- 5.2 years. Insulation defects caused the majority of lead failures, and most of these leads used polyurethane materials. Lead failure was associated with a 16% incidence of major adverse clinical events. No major adverse clinical events occurred when impending lead failure was detected at routine follow-up. Lead extraction was associated with a 5.6% complication rate, including one death. CONCLUSION Overall pulse generator performance was satisfactory. Differences in battery longevity were observed among models. In some patients, elective replacement indicators signifying normal battery depletion resulted in major adverse clinical events. Pacemaker follow-up effectively identified pulse generator end-of-service life and often detected impending lead failure, thus avoiding major adverse clinical events. Long-term studies are needed to assess chronic lead performance so that appropriate clinical management strategies, including recommendations for lead extraction, can be developed.
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Affiliation(s)
- Robert G Hauser
- Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA.
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Ruiz-Mateas F, Sancho-Tello MJ, Coma-Sanmartín R, Fidalgo-Andrés M, Martínez-Ferrere J, García-Calabozo R. Novedades en estimulación cardiaca 2006. Rev Esp Cardiol (Engl Ed) 2007; 60 Suppl 1:92-100. [PMID: 17352859 DOI: 10.1157/13099716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
This article summarizes progress in cardiac pacing that has taken place in the last year, such as the incorporation of navigation technology into programmers, systems for monitoring hemodynamic parameters, and new developments in patient follow-up, principally home monitoring and the use of treatment guidelines. In addition, the article covers recent findings in resynchronization therapy, paroxysmal atrial fibrillation, and the management of patients with pacemakers who need to undergo magnetic resonance imaging.
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Affiliation(s)
- Francisco Ruiz-Mateas
- Unidad de Estimulación Cardiaca, Unidad de Cardiología, Hospital Costa del Sol, Marbella, España
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