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de Maat GE, Mulder BA, Van de Lande ME, Rama RS, Rienstra M, Mariani MA, Maass AH, Klinkenberg TJ. Long-Term Performance of Epicardial versus Transvenous Left Ventricular Leads for Cardiac Resynchronization Therapy. J Clin Med 2023; 12:5766. [PMID: 37762709 PMCID: PMC10531585 DOI: 10.3390/jcm12185766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Aims: to study the technical performance of epicardial left ventricular (LV) leads placed via video assisted thoracic surgery (VATS), compared to transvenously placed leads for cardiac resynchronization therapy (CRT). Methods: From 2001 until 2013, a total of 644 lead placement procedures were performed for CRT. In the case of unsuccessful transvenous LV lead placement, the patient received an epicardial LV lead. Study groups consist of 578 patients with a transvenous LV lead and 66 with an epicardial LV lead. The primary endpoint was LV-lead failure necessitating a replacement or deactivation. The secondary endpoint was energy consumption. Results: The mean follow up was 5.9 years (epicardial: 5.5 ± 3.1, transvenous: 5.9 ± 3.5). Transvenous leads failed significantly more frequently than epicardial leads with a total of 66 (11%) in the transvenous leads group vs. 2 (3%) in the epicardial lead group (p = 0.037). Lead energy consumption was not significantly different between groups. Conclusions: Epicardial lead placement is feasible, safe and shows excellent long-term performance compared to transvenous leads. Epicardial lead placement should be considered when primary transvenous lead placement fails or as a primary lead placement strategy in challenging cases.
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Affiliation(s)
- Gijs E. de Maat
- Department of Cardio-Thoracic Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (G.E.d.M.); (M.A.M.); (T.J.K.)
| | - Bart A. Mulder
- Department of Cardiology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (B.A.M.); (M.E.V.d.L.); (R.S.R.); (M.R.)
| | - Martijn E. Van de Lande
- Department of Cardiology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (B.A.M.); (M.E.V.d.L.); (R.S.R.); (M.R.)
| | - Rajiv S. Rama
- Department of Cardiology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (B.A.M.); (M.E.V.d.L.); (R.S.R.); (M.R.)
| | - Michiel Rienstra
- Department of Cardiology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (B.A.M.); (M.E.V.d.L.); (R.S.R.); (M.R.)
| | - Massimo A. Mariani
- Department of Cardio-Thoracic Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (G.E.d.M.); (M.A.M.); (T.J.K.)
| | - Alexander H. Maass
- Department of Cardiology, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (B.A.M.); (M.E.V.d.L.); (R.S.R.); (M.R.)
| | - Theo J. Klinkenberg
- Department of Cardio-Thoracic Surgery, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands; (G.E.d.M.); (M.A.M.); (T.J.K.)
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Kewcharoen J, Contractor T, Kotak K, Prasad V. Management of an Inadvertently Placed Transarterial Pacemaker Lead in the Left Ventricle: A Step-by-step Approach. J Innov Card Rhythm Manag 2023; 14:5482-5487. [PMID: 37388424 PMCID: PMC10306246 DOI: 10.19102/icrm.2023.14064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/20/2022] [Indexed: 07/01/2023] Open
Abstract
Inadvertent lead misplacement in the left ventricle can lead to thromboembolic events, valvular damage, and endocarditis. We present a case of an inadvertently placed transarterial pacemaker lead in the left ventricle in a patient who underwent percutaneous lead removal. After a multidisciplinary team discussion involving cardiac electrophysiology and interventional cardiology as well as a discussion of treatment options with the patient, it was decided to proceed with pacemaker lead removal with the Sentinel™ Cerebral Protection System (Boston Scientific, Marlborough, MA, USA) to prevent thromboembolic events. The patient tolerated the procedure well without post-procedural complications and was discharged the next day on oral anticoagulation. We also present a step-by-step approach to perform lead removal with the use of Sentinel™, emphasizing mitigating the stroke and bleeding risks in this patient setting.
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Affiliation(s)
- Jakrin Kewcharoen
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Tahmeed Contractor
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Kamal Kotak
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Vinoy Prasad
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA
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Kim J, Lee SH, Kim HR, Chung TW, Choi JH, Kim JY, Park KM, On YK, Kim JS, Park SJ. Orthodromic and Antidromic Snare Techniques for Left Ventricular Lead Implantation in Cardiac Resynchronization Therapy. J Clin Med 2022; 11:2133. [PMID: 35456225 DOI: 10.3390/jcm11082133] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 02/04/2023] Open
Abstract
The snare technique can be used to overcome unsuitable cardiac venous anatomies for left ventricular (LV) lead implantation in cardiac resynchronization therapy (CRT) procedures. However, limited data exist regarding performance of the snare technique. We classified 262 patients undergoing CRT procedure into the snare (n = 20) or conventional group (n = 242) according to the LV lead implantation method. We compared the safety, efficacy, and composite outcome (all-cause death and heart failure readmission) at 3 years post-implant between the snare and conventional groups. In the snare group, all LV leads were implanted safely using orthodromic (n = 15) or antidromic (n = 5) techniques, and no immediate complications occurred including vessel perforation, tamponade, and lead dislodgement. During follow-up, LV lead threshold and impedance remained stable without requiring lead revision in the snare group. There were no significant between-group differences regarding LV ejection fraction increase (12 ± 13% vs. 12 ± 13%, p = 0.929) and LV end-systolic volume reduction (18 ± 48% vs. 28 ± 31%, p = 0.501). Both groups exhibited comparable CRT-response rates (62.5% vs. 60.6%, p = 1.000). The risk of primary outcome was not significantly different between the two groups (25.9% vs. 30.9%, p = 0.817). In patients who failed conventional LV lead implantation for CRT, the snare technique could be a safe and effective solution to overcome difficult coronary venous anatomy.
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Schiedat F, Bogossian H, Schöne D, Aweimer A, Patsalis PC, Hanefeld C, Mügge A, Kloppe A. Long-Term Performance Comparison of Bipolar Active vs. Quadripolar Passive Fixation Leads in Cardiac Resynchronisation Therapy. Front Cardiovasc Med 2021; 8:734666. [PMID: 34881300 PMCID: PMC8645570 DOI: 10.3389/fcvm.2021.734666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Bipolar active fixation (BipolarAFL) and quadripolar passive fixation left-ventricular leads (QuadPFL) have been designed to reduce the risk of phrenic nerve stimulation (PNS), enable targeted left-ventricular pacing, and overcome problems of difficult coronary venous anatomy and lead dislodgment. This study sought to report the long-term safety and performance of a BipolarAFL, Medtronic Attain Stability 20066, compared to QuadPFL. Methods: We performed a single-operator retrospective analysis of 81 patients receiving cardiac resynchronization therapy (CRT) (36 BipolarAFL, 45 QuadPFL). Immediate implant data and electrical and clinical data during follow-up (FU) were analyzed. Results: BipolarAFL has been chosen in patients with significantly larger estimated vein diameter (at the lead tip: 7.2 ± 4.1 Fr vs. 4.1 ± 2.3 Fr, p < 0.001) without significant time difference until the final lead position was achieved (BipolarAFL: 20.9 ± 10.5 min, vs. QuadPFL: 18.9 ± 8.9 min, p = 0.35). At 12 month FU no difference in response rate to CRT was recorded between BipolarAFL and QuadPFL according to left ventricular end-systolic volume (61.1 vs. 60.0%, p = 0.82) and New York Heart Association (66.7 vs. 62.2%, p = 0.32). At median FU of 48 months (IQR: 44-54), no lead dislodgment occurred in both groups but a significantly higher proportion of PNS was recorded in QuadPFL (13 vs. 0%, p < 0.05). Electrical parameters were stable during FU in both groups without significant differences. Conclusion: BipolarAFL can be implanted with ease in challenging coronary venous anatomy, shows excellent electrical performance and no difference in clinical outcome compared to QuadPFL.
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Affiliation(s)
- Fabian Schiedat
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, Bochum, Germany.,Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | | | - Dominik Schöne
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, Bochum, Germany
| | - Polykarpos C Patsalis
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, Bochum, Germany
| | - Christoph Hanefeld
- Department of Internal Medicine at Elisabeth Krankenhaus Bochum of the Ruhr University Bochum, Bochum, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, Bochum, Germany
| | - Axel Kloppe
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
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Kronborg MB, Stephansen C, Kristensen J, Gerdes C, Nielsen JC. Reproducibility and repeatability of identifying the latest electrical activation during mapping of coronary sinus branches in CRT recipients. J Cardiovasc Electrophysiol 2020; 31:2940-2947. [PMID: 32852869 DOI: 10.1111/jce.14729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Studies have shown an association between the outcome in cardiac resynchronization therapy (CRT) and longer interventricular delay at the site of the left ventricular (LV) lead. Targeted LV lead placement at the latest electrically activated segment increases LV function further as compared with standard treatment. We aimed to determine reproducibility and repeatability of identifying the latest electrically activated segment during mapping of all available coronary sinus (CS) branches in patients receiving CRT. METHODS We included 35 patients who underwent CRT implantation with protocolled mapping guided LV lead implantation aiming for the site of the latest electrical activation. Three different doctors experienced in electrophysiology and implantation of CRT devices independently measured time interval from the local bipolar right ventricular (RV) electrogram (EGM) to the local unipolar LV EGM at all mapped sites (RV-LV). The segment with the latest electrical activation was defined as the target segment (TS) and the CS tributary containing TS was defined as the target vein (TV). Weighted κ statistics with 95% confidence intervals were computed to assess intra- and interobserver agreement for TS and TV. RESULTS We mapped 258 segments within 131 veins. Weighted κ values for repeatability were 0.85 (0.81-0.89) for TS and 0.92 (0.89-0.93) for TV, and weighted κ values of interobserver agreement ranged from 0.70 (0.61-0.73) to 0.80 (0.76-0.83) for TS and 0.73 (0.64-0.78) to 0.86 (0.83-0.89) for TV among all three observers. CONCLUSION The reproducibility and repeatability of identifying the latest electrically activated segment during mapping of all available CS branches in patients receiving CRT range from good to very good.
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Affiliation(s)
- Mads B Kronborg
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens C Nielsen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Ghazzal B, Sabayon D, Kiani S, Leon AR, Delurgio D, Patel AM, Lloyd MS, Westerman S, Shah A, Merchant FM, El-Chami MF. Cardiac implantable electronic devices in patients with persistent left superior vena cava-A single center experience. J Cardiovasc Electrophysiol 2020; 31:1175-1181. [PMID: 32237003 DOI: 10.1111/jce.14460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/17/2020] [Accepted: 03/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are limited data on cardiac implantable electronic device implantation (CIED) in patients with persistent left superior vena cava (PLSVC). OBJECTIVE To describe the outcomes of implanting CIEDs with a focus on cardiac resynchronization therapy (CRT) in patients with PLSVC. METHODS We identified all patients with a PLSVC that underwent CIED implantation from December 2008 until February 2019 at our institution by querying the electronic medical record (n = 34). We then identified controls in a 3:1 fashion (n = 102) by matching on device type (CRT vs non-CRT). Procedure success, complications, fluoroscopy and procedural time were recorded. Outcomes were compared using a two-way analysis of variance test and conditional regression modeling for continuous and categorical variables, respectively. RESULTS A total of 34 patients with PLSVC underwent 38 procedures. Four patients underwent dual chamber system implantation followed by a subsequent upgrade to CRT. Thirteen patients underwent CRT implantation: one was implanted via the right subclavian while the rest were implanted via the PLSVC. Left ventricular (P = .06). Procedure and fluoroscopy times were significantly higher in the PLSVC as compared with the control group (97.7 vs 66.1 minute, P < .001 and 18.1 minute vs 8.7 minutes, P = .005, respectively). CONCLUSION CIED implant in patients with PLSVC is feasible but technically more challenging and appears to be associated with higher risk of right ventricular lead dislodgment.
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Affiliation(s)
- Bahjat Ghazzal
- Department of Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Dean Sabayon
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Soroosh Kiani
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Angel R Leon
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - David Delurgio
- Division of Cardiac Electrophysiology, Emory University, Atlanta, Georgia
| | - Anshul M Patel
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Michael S Lloyd
- Division of Cardiovascular Electrophysiology, Emory University, Atlanta, Georgia
| | - Stacy Westerman
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Anand Shah
- Division of Cardiovascular Electrophysiology, Emory University, Atlanta, Georgia
| | - Faisal M Merchant
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Mikhael F El-Chami
- Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
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Tan VH, Yeo C, Wong K. Suboptimal biventricular pacing. What is the mechanism? J Arrhythm 2019; 35:673-675. [PMID: 31410239 PMCID: PMC6686292 DOI: 10.1002/joa3.12207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 05/07/2019] [Accepted: 05/14/2019] [Indexed: 11/07/2022] Open
Abstract
Suboptimal biventricular pacing has deleterious effects on patients with cardiac resynchronization therapy. We describe a unique case of suboptimal biventricular pacing and our approach to overcome it.
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Affiliation(s)
- Vern Hsen Tan
- Cardiology DepartmentChangi General HospitalSingaporeSingapore
| | - Colin Yeo
- Cardiology DepartmentChangi General HospitalSingaporeSingapore
| | - Kelvin Wong
- Cardiology DepartmentChangi General HospitalSingaporeSingapore
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Ziacchi M, Palmisano P, Biffi M, Guerra F, Stabile G, Forleo GB, Zanotto G, D'Onofrio A, Landolina M, De Ponti R, Zoni Berisso M, Ricci RP, Boriani G. Lead choice in cardiac implantable electronic devices: an Italian survey promoted by AIAC (Italian Association of Arrhythmias and Cardiac Pacing). Expert Rev Med Devices 2019; 16:821-828. [PMID: 31348864 DOI: 10.1080/17434440.2019.1649134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Few data are available regarding lead preferences of electrophysiologists during cardiac implantable electronic devices (CIEDs) implantation. Aim of this survey is to evaluate the leads used, and the reasons behind these choices, in a large population of implanters. Methods: A questionnaire was sent to all 314 Italian centers with experience in CIED implantation. Results: 103 operators from 100 centers (32% of centers) responded. For atrium, passive leads represented first choice for pacemakers and defibrillators (71% and 64% of physicians, respectively), mainly for safety. For right ventricle, active fixation was preferred (61% and 93% operators in pacemaker and defibrillator patients), for higher versatility in positioning and lower dislodgement risk. For left ventricular stimulation, quadripolar leads were preferred by more than 80% of respondents, for better phrenic nerve and myocardial threshold management; active-fixation leads represent a second choice, in order to prevent or manage dislodgement (78% and 17% of respondents, respectively), but 44% of operators considered them dangerous. Conclusions: The choice of leads is heterogeneous. Trends are toward active-fixation right ventricular leads and passive-fixation atrial leads (particularly in pacemaker patients, considered frailer). For left ventricular stimulation, operators' majority want to disposition all kind of leads, although quadripolar leads are the favorites.
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Affiliation(s)
- Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital , Bologna , Italy
| | | | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital , Bologna , Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University , Ancona , Italy
| | | | | | | | | | | | - Roberto De Ponti
- Department of Heart and Vessels, Circolo Hospital, University of Insubria , Varese , Italy
| | | | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena , Italy
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Herrmann FEM, Fichtner S, Sadoni S. Successful Left Ventricular Lead Placement in Congenitally Corrected Transposition of the Great Arteries and Situs Inversus. JACC Clin Electrophysiol 2019; 5:404-405. [PMID: 30898247 DOI: 10.1016/j.jacep.2018.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/05/2018] [Accepted: 11/15/2018] [Indexed: 11/19/2022]
Affiliation(s)
| | | | - Sebastian Sadoni
- Department of Cardiac Surgery, Ludwig Maximilian University, Munich, Germany
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10
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Zhou W, Tao N, Hou X, Wang Y, Folks RD, Cooke DC, Moncayo VM, Garcia EV, Zou J. Development and validation of an automatic method to detect the latest contracting viable left ventricular segments to assist guide CRT therapy from gated SPECT myocardial perfusion imaging. J Nucl Cardiol 2018; 25:1948-1957. [PMID: 28353213 PMCID: PMC10981925 DOI: 10.1007/s12350-017-0853-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 03/05/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The purpose of this study is to use ECG-gated SPECT MPI to detect the latest contracting viable left ventricular (LV) segments to help guide the LV probe placement used in CRT therapy and to validate segment selection against the visual integration method by experts. METHODS For each patient, the resting ECG-gated SPECT MPI short-axis images were sampled in 3D to generate a polar map of the perfusion distribution used to determine LV myocardial viability, and to measure LV synchronicity using our phase analysis tool. In the visual integration method, two experts visually interpreted the LV viability and mechanical dyssynchrony from the short-axis images and polar maps of viability and phase, to determine the latest contracting viable segments using the 17-segment model. In the automatic method, the apical segments, septal segments, and segments with more than 50% scar were excluded as these are not candidates for CRT LV probe placement. Amongst the remaining viable segments, the segments, whose phase angles were within 10° of the latest phase angle (the most delayed contracting segment), were identified for potential CRT LV probe placement and ranked based on the phase angles of the segments. Both methods were tested in 36 pre-CRT patients who underwent ECG-gated SPECT MPI. The accuracy was determined as the percent agreement between the visual integration and automatic methods. The automatic method was performed by a second independent operator to evaluate the inter-operator processing reproducibility. RESULTS In all the 36 patients, the LV lead positions of the 1st choices recommended by the automatic and visual integration methods were in the same segments in 35 patients, which achieved an agreement rate of 97.2%. In the inter-operator reproducibility test, the LV lead positions of the 1st choices recommended by the two operators were in the same segments in 25 patients, and were in the adjacent segments in 7 patients, which achieved an overall agreement of 88.8%. CONCLUSIONS An automatic method has been developed to detect the latest contracting viable LV segments to help guide the LV probe placement used in CRT therapy. The retrospective clinical study with 36 patients suggests that this method has high agreement against the visual integration method by experts and good inter-operator reproducibility. Consequently, this method is promising to be a clinical tool to recommend the CRT LV lead positions.
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Affiliation(s)
- Weihua Zhou
- School of Computing, University of Southern Mississippi, Long Beach, MS, USA
| | - Ningchao Tao
- Department of Cardiology, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Xiaofeng Hou
- Department of Cardiology, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Yao Wang
- Department of Cardiology, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Russell D Folks
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30032, USA
| | - David C Cooke
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30032, USA
| | - Valeria M Moncayo
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30032, USA
| | - Ernest V Garcia
- Department of Radiology, Emory University School of Medicine, Atlanta, GA, 30032, USA.
| | - Jiangang Zou
- Department of Cardiology, Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
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Bisson A, Pucheux J, Andre C, Bernard A, Pierre B, Babuty D, Fauchier L, Clementy N. Localization of Left Ventricular Lead Electrodes in Relation to Myocardial Scar in Patients Undergoing Cardiac Resynchronization Therapy. J Am Heart Assoc 2018; 7:e009502. [PMID: 30373444 PMCID: PMC6404211 DOI: 10.1161/jaha.118.009502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The efficacy of cardiac resynchronization therapy may be reduced in the event of pacing within myocardial fibrosis. We aimed to develop a method to determine the anatomical relationships between the left ventricular (LV) lead and myocardial fibrosis. Methods and Results In consecutive patients indicated for cardiac resynchronization therapy, cardiovascular magnetic resonance imaging with late gadolinium enhancement assessment was performed before implantation. After implantation, an injected computed tomography scanner (CT scan) was performed. The 2 imaging techniques were fused to assess the LV lead position relative to myocardial scar. A total of 68 patients were included. Myocardial scar was found in 29 (43%) and was localized in lateral segments in 14 (21%). Scar was significantly associated with male sex, ischemic cardiomyopathy, a Selvester score adapted to left bundle branch block (LBBB Selvester), and Selvester criteria for localizing lateral fibrosis (V2 S/S′ ratio). Image fusion was feasible in all patients. Position within myocardial scar was confirmed for 6 electrodes in 3 patients. Prolonged QRS duration during LV pacing ≥139% predicted electrode positioning within scar tissue (sensitivity, 83%; specificity, 91%; P=0.002). Conclusions In cardiac resynchronization therapy patients, fusion between preimplantation cardiovascular magnetic resonance and a postimplantation injected computed tomography scan is a feasible technique. Prolongation of the QRS duration during LV pacing predicts pacing within myocardial scar. Accurate location of LV lead pacing electrodes on the epicardial surface relative to myocardial scar, either by imaging or ECG analyses, may help improve cardiac resynchronization therapy response in selected patients.
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Affiliation(s)
- Arnaud Bisson
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Julien Pucheux
- 2 Radiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Clémentine Andre
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Anne Bernard
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Bertrand Pierre
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Dominique Babuty
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Laurent Fauchier
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
| | - Nicolas Clementy
- 1 Cardiology Department Centre Hospitalier Universitaire Trousseau et Faculté de Médecine Université de Tours France
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Motallebi M, Feizabadi N. Cardiac Resynchronization Therapy Upgrade in a Patient with Dextrocardia and Situs Inversus Totalis, Facilitated by Coronary Sinus Cannulation with Electrophysiology Catheters from Both Femoral and Axillary Venous Approaches. J Innov Card Rhythm Manag 2018; 9:3084-3089. [PMID: 32477805 PMCID: PMC7252748 DOI: 10.19102/icrm.2018.090401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 01/15/2018] [Indexed: 11/06/2022] Open
Abstract
Cardiac resynchronization therapy in patients with dextrocardia with situs inversus totalis can be technically challenging. There are few case reports of cardiac resynchronization therapy implantation in these individuals. Here, we describe a procedure of cardiac resynchronization therapy upgrade in a patient with dextrocardia and situs inversus totalis facilitated by coronary sinus cannulation from both the femoral and axillary venous approaches.
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Affiliation(s)
- Mazda Motallebi
- Cardiovascular and Electrophysiology Services, CareMore Health Plan, Los Angeles, CA, USA,Cardiac Electrophysiology Laboratory, Lakewood Regional Medical Center, Lakewood, CA, USA,Address correspondence to: Mazda Motallebi, MD, FHRS, FACC, CCDS, CareMore Care Center, 10000 Lakewood Boulevard, Downey, CA 90240, USA.
| | - Narges Feizabadi
- Cardiovascular and Electrophysiology Services, CareMore Health Plan, Los Angeles, CA, USA
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Manolis AS, Koulouris S, Tsiachris D. Electrophysiology Catheter-Facilitated coronary sinus cannulation and implantation of cardiac resynchronization therapy systems. Hellenic J Cardiol 2017; 59:26-33. [PMID: 28778735 DOI: 10.1016/j.hjc.2017.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/20/2017] [Accepted: 07/21/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cardiac resynchronization therapy (CRT) device implantation is hampered by difficult placement of the left ventricular (LV) lead. We have routinely used a steerable electrophysiology catheter to guide coronary sinus (CS) cannulation and facilitate LV lead positioning. The aim of this prospective study is to present our results with this approach in 138 consecutive patients receiving a CRT device over 10 years. METHODS The study included 120 men and 18 women, aged 64.8±11.4 years, with coronary disease (n=63), cardiomyopathy (n=72), or other disease (n=3), and mean ejection fraction of 24.5±4.5%. Devices were implanted for refractory heart failure and dyssynchrony, all but 2 in the presence of left bundle branch block. Implanted devices included biventricular pacemakers (CRT-P) (n=33) and cardioverter defibrillators (CRT-D) (n=105). RESULTS Using the electrophysiology catheter, the CS could be engaged in 134 (97.1%) patients. In 4 patients failing CS cannulation, a dual-chamber device was implanted in 2, and bifocal right ventricular pacing was effected in 2. Bifocal (n=2) or conventional (n=1) systems were implanted in another 3 patients, in whom the LV lead got dislodged (n=2) or removed because of local dissection (n=1). Thus, finally, a CRT system was successfully established in 131 (94.9%) patients. There were 3 patients with CS dissection, of whom 1 was complicated by cardiac tamponade managed with pericardiocentesis. There were no perioperative deaths. During follow-up (31.0±21.2 months), clinical improvement was reported by 108 (82.4%) patients. CONCLUSION Routine use of an electrophysiology catheter greatly facilitated CS cannulation and successful LV lead placement in ∼95% of patients undergoing CRT system implantation.
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Affiliation(s)
- Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece.
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Tomassoni G, Baker J, Corbisiero R, Love C, Martin D, Sheppard R, Worley SJ, Lee K, Niazi I. Rationale and design of a randomized trial to assess the safety and efficacy of MultiPoint Pacing (MPP) in cardiac resynchronization therapy: The MPP Trial. Ann Noninvasive Electrocardiol 2017; 22. [PMID: 28517367 DOI: 10.1111/anec.12448] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 03/10/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Although the majority of Class III congestive heart failure (HF) patients treated with cardiac resynchronization therapy (CRT) show a clinical benefit, up to 40% of patients do not respond to CRT. This paper reports the design of the MultiPoint Pacing (MPP) trial, a prospective, randomized, double-blind, controlled study to evaluate the safety and efficacy of CRT using MPP compared to standard biventricular (Bi-V) pacing. METHODS A maximum of 506 patients with a standard CRT-D indication will be enrolled at up to 50 US centers. All patients will be implanted with a CRT-D system (Quartet LV lead Model 1458Q with a Quadra CRT-D, Abbott) that can deliver both MPP and Bi-V pacing. Standard Bi-V pacing will be activated at implant. At 3 months postimplant, patients in whom the echocardiographic parameters during MPP are equal or better than during Bi-V pacing are randomized (1:1) to either an MPP or Bi-V arm. RESULTS The primary safety endpoint is freedom from system-related complications at 9 months. Each patient's response to CRT will be evaluated using a heart-failure clinical composite score, consisting of a change in NYHA functional class, patient global assessment score, HF events, and cardiovascular death. The primary efficacy endpoint is the proportion of responders in the MPP arm compared with the Bi-V arm between 3 and 9 months. CONCLUSION This trial seeks to evaluate whether MPP via a single quadripolar LV lead improves hemodynamic and clinical responses to CRT, both in clinical responders and nonresponders.
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Affiliation(s)
| | - James Baker
- Saint Thomas Research Institute, Nashville, TN, USA
| | | | | | - David Martin
- Lahey Hospital and Medical Center - Cardiology, Burlington, MA, USA
| | | | | | | | - Imran Niazi
- Aurora Cardiovascular Services, Milwaukee, WI, USA
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Osztheimer I, Szilágyi S, Pongor Z, Zima E, Molnár L, Tahin T, Merkely B, Gellér L. Minimal Invasive Left Ventricular Lead Repositioning is Safe and Effective in Distal Left Ventricular Lead Positions. Pacing Clin Electrophysiol 2017; 40:488-493. [PMID: 28240382 DOI: 10.1111/pace.13068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/18/2017] [Accepted: 02/06/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Treatment of left ventricular electrode dislocation and phrenic nerve stimulation remains an issue in the era of new electrode designs. METHODS Safety and efficacy of minimal invasive lead repositioning and pocket opening reposition procedures were evaluated between December 2005 and December 2012 at our center. Minimal invasive method was developed and widely utilized at our center to treat phrenic nerve stimulation. The distally positioned left ventricular lead is looped around by a deflectable catheter in the right atrium introduced from the femoral vein access and then pulled back. Coronary stent implantation was used afterwards for lead stabilization in some patients. RESULTS 42 minimal invasive and 48 electrode repositions with pacemaker pocket opening were performed at 77 patients for left ventricular lead problems. Minimal invasive reposition could be carried out successfully in 69% of (29 patients) cases. Note that in 14.3% of the cases (six patients) minimal invasive procedures were acutely unsuccessful and crossover was necessary. In 16.6% of the cases (seven patients) lead issues were noted later during follow-up. Opening of the pocket could be carried out successfully in 81.2% (39 patients) and was unsuccessful acutely in 6.25% (three patients). Repeated dislocation was noticed, 12.5%, in this group (six patients). Complication during minimal invasive procedures was electrode injury in one case. Pocket openings were associated with several complications: atrial fibrillation, pericardial effusion, fever, hematoma, and right ventricular electrode dislodgement. CONCLUSION Minimal invasive procedure-as the first line approach-is safe and feasible for left ventricular electrode repositioning in selected cases.
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Affiliation(s)
| | | | - Zsuzsanna Pongor
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Endre Zima
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Levente Molnár
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Tamás Tahin
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - Béla Merkely
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
| | - László Gellér
- Semmelweis University Heart and Vascular Center, Budapest, Hungary
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Polasek R, Skalsky I, Wichterle D, Martinca T, Hanuliakova J, Roubicek T, Bahnik J, Jansova H, Pirk J, Kautzner J. High-density epicardial activation mapping to optimize the site for video-thoracoscopic left ventricular lead implant. J Cardiovasc Electrophysiol 2014; 25:882-888. [PMID: 24724625 PMCID: PMC4369134 DOI: 10.1111/jce.12430] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/26/2014] [Accepted: 03/10/2014] [Indexed: 11/30/2022]
Abstract
Background The left ventricular (LV) lead local electrogram (EGM) delay from the beginning of the QRS complex (QLV) is considered a strong predictor of response to cardiac resynchronization therapy. We have developed a method for fast epicardial QLV mapping during video-thoracoscopic surgery to guide LV lead placement. Methods A three-port, video-thoracoscopic approach was used for LV free wall epicardial mapping and lead implantation. A decapolar electrophysiological catheter was introduced through one port and systematically attached to multiple accessible LV sites. The pacing lead was targeted to the site with maximum QLV. The LV free wall activation pattern was analyzed in 16 pre-specified anatomical segments. Results We implanted LV leads in 13 patients with LBBB or IVCD. The procedural and mapping times were 142 ± 39 minutes and 20 ± 9 minutes, respectively. A total of 15.0 ± 2.2 LV segments were mappable with variable spatial distribution of QLV-optimum. The QLV ratio (QLV/QRSd) at the optimum segment was significantly higher (by 0.17 ± 0.08, p < 0.00001) as compared to an empirical midventricular lateral segment. The LV lead was implanted at the optimum segment in 11 patients (at an adjacent segment in 2 patients) achieving a QLV ratio of 0.82 ± 0.09 (range 0.63–0.93) and 99.5 ± 0.6% match with intraprocedural mapping. Conclusion Video-thoracoscopic LV lead implantation can be effectively and safely guided by epicardial QLV mapping. This strategy was highly successful in targeting the selected LV segment and resulted in significantly higher QLV ratios compared to an empirical midventricular lateral segment.
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Affiliation(s)
- Rostislav Polasek
- Department of Cardiology, Regional Hospital Liberec, Husova, Liberec, Czech Republic
| | - Ivo Skalsky
- Cardiology Centre, Institute for Clinical and Experimental Medicine, Videnska, Prague, Czech Republic
| | - Dan Wichterle
- Cardiology Centre, Institute for Clinical and Experimental Medicine, Videnska, Prague, Czech Republic
| | - Tomas Martinca
- Cardiology Centre, Institute for Clinical and Experimental Medicine, Videnska, Prague, Czech Republic
| | - Jana Hanuliakova
- Department of Cardiology, Regional Hospital Liberec, Husova, Liberec, Czech Republic
| | - Tomas Roubicek
- Department of Cardiology, Regional Hospital Liberec, Husova, Liberec, Czech Republic
| | - Jan Bahnik
- Department of Cardiology, Regional Hospital Liberec, Husova, Liberec, Czech Republic
| | - Helena Jansova
- Cardiology Centre, Institute for Clinical and Experimental Medicine, Videnska, Prague, Czech Republic
| | - Jan Pirk
- Cardiology Centre, Institute for Clinical and Experimental Medicine, Videnska, Prague, Czech Republic
| | - Josef Kautzner
- Cardiology Centre, Institute for Clinical and Experimental Medicine, Videnska, Prague, Czech Republic
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Miller AL, Kramer DB, Lewis EF, Koplan B, Epstein LM, Tedrow U. Event-free survival following CRT with surgically implanted LV leads versus standard transvenous approach. Pacing Clin Electrophysiol 2011; 34:490-500. [PMID: 21463344 PMCID: PMC3079428 DOI: 10.1111/j.1540-8159.2010.03014.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND While surgical epicardial lead placement is performed in a subset of cardiac resynchronization therapy patients, data comparing survival following surgical versus transvenous lead placement are limited. We hypothesized that surgical procedures would be associated with increased mortality risk. METHODS Long-term event-free survival was assessed for 480 consecutive patients undergoing surgical (48) or percutaneous (432) left ventricle (LV) lead placement at our institution from January 2000 to September 2008. RESULTS Baseline clinical and demographic characteristics were similar between groups. While there was no statistically significant difference in overall event-free survival (P = 0.13), when analysis was restricted to surgical patients with isolated surgical lead placement (n = 28), event-free survival was significantly lower in surgical patients (P = 0.015). There appeared to be an early risk (first approximately 3 months postimplantation) with surgical lead placement, primarily in LV lead-only patients. Event rates were significantly higher in LV lead-only surgical patients than in transvenous patients in the first 3 months (P = 0.006). In proportional hazards analysis comparing isolated surgical LV lead placement to transvenous lead placement, adjusted hazard ratios were 1.8 ([1.1,2.7] P = 0.02) and 1.3 ([1.0,1.7] P = 0.07) for the first 3 months and for the full duration of follow-up, respectively. CONCLUSIONS Isolated surgical LV lead placement appears to carry a small but significant upfront mortality cost, with risk extending beyond the immediate postoperative period. Long-term survival is similar, suggesting those surviving beyond this period of early risk derive the same benefit as coronary sinus lead recipients. Further work is needed to identify risk factors associated with early mortality following surgical lead placement.
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Affiliation(s)
- Amy L Miller
- Department of Medicine, Cardiovascular Division, Brigham & Women's Hospital, Boston, Massachusetts, USA.
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McManus DD, Mattei ML, Rose K, Rashkin J, Rosenthal LS. Inadvertent lead placement in the left ventricle: a case report and brief review. Indian Pacing Electrophysiol J 2009; 9:224-8. [PMID: 19652735 PMCID: PMC2705321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Inadvertent lead placement in the left ventricle (LV) is an uncommon and often under-diagnosed complication of cardiac device implantation. Thromboembolic (TE) events are common and usually secondary to fibrosis or thrombus formation on or around the lead. Anticoagulation can prevent TE events. Percutaneous and surgical LV lead extractions have been performed successfully, but the risks of percutaneous lead removal are not well-defined. In this report, we describe a case of inadvertent LV lead placement and briefly review the contemporary literature.
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Sperzel J, Reiner C, Schwarz T, Ehrlich W, Neumann T, Güttler N, Kurzidim K, Pitschner HF. Left ventricular leads used in cardiac resynchronization therapy for heart failure patients. Herzschrittmacherther Elektrophysiol 2001; 12:195-203. [PMID: 27432389 DOI: 10.1007/s003990170004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cardiac resynchronization therapy (CRT) has been introduced as a treatment for selected heart failure patients, specifically those with symptomatic heart failure, left ventricular (LV) dysfunction, and intraventricular conduction delays. CRT is delivered by use of an implanted device and leads positioned in the right atrium, right ventricle, and left ventricle. In the early stages of CRT development, researchers affixed epicardial electrodes to the left ventricle by means of subxiphoid, thoracoscopic, or major surgical procedure. Currently there are a number of transvenous LV leads available that have undergone substantial evaluation. Reports indicate that such leads can be positioned safely by cannulating the coronary sinus and inserting the lead into the venous system. The leads are reported to have acceptable pacing/sensing thresholds and complication rates. Because of individual variations in the cardiac and venous anatomy, as well as sharp angulations in the venous system, maneuverability is an important consideration in lead selection.
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Affiliation(s)
- J Sperzel
- Kerckhoff-Klinik Dept. Electrophysiology Benekestraße 2-8 61231 Bad Nauheim, Germany E-Mail: . uni-giessen.de, Germany
| | - C Reiner
- Kerckhoff-Klinik Dept. Electrophysiology Benekestraße 2-8 61231 Bad Nauheim, Germany E-Mail: . uni-giessen.de, Germany
| | - T Schwarz
- Kerckhoff-Klinik Dept. Heart Surgery Benekestraße 2-8 61231 Bad Nauheim, Germany, Germany
| | - W Ehrlich
- Kerckhoff-Klinik Dept. Heart Surgery Benekestraße 2-8 61231 Bad Nauheim, Germany, Germany
| | - T Neumann
- Kerckhoff-Klinik Dept. Electrophysiology Benekestraße 2-8 61231 Bad Nauheim, Germany E-Mail: . uni-giessen.de, Germany
| | - N Güttler
- Kerckhoff-Klinik Dept. Electrophysiology Benekestraße 2-8 61231 Bad Nauheim, Germany E-Mail: . uni-giessen.de, Germany
| | - K Kurzidim
- Kerckhoff-Klinik Dept. Electrophysiology Benekestraße 2-8 61231 Bad Nauheim, Germany E-Mail: . uni-giessen.de, Germany
| | - H F Pitschner
- Kerckhoff-Klinik Dept. Electrophysiology Benekestraße 2-8 61231 Bad Nauheim, Germany E-Mail: . uni-giessen.de, Germany
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