The active fixation lead 4195 using retention lobes yielded stable thresholds over time and seems to be superior to conventional leads in terms of dislocation. However, extraction may be a difficult or even impossible task.
Upgrade patients showed similar baseline parameters and response to CRT as to primary implants. No difference in events or long-term prognosis could be observed.
Post-mortem analysis of arrhythmia monitoring of pacemaker patients revealed tachycardias (most likely ventricular tachycardia) to be related to sudden death. These findings give some insight in mechanisms of terminal events in this group.
Chronic CRT improves ejection fraction, BNP and hemodynamic measurements predominantly in patients with lateral and posterior CS lead positions. Anterior lead positions should be avoided.
Cardiac Resynchronization therapy (CRT) using coronary sinus (CS) leads is an established method for the therapy of congestive heart failure (CHF) in the case of inter- and intraventricular conduction delays. However implantation of CS leads is somewhat challenging due to a high number of peri- or postoperative dislocations at a rate of about 10%. The retained guidewire technique has been proposed for the implantation of coronary sinus leads for stabilization in case of repetitive intraoperative dislocations. This report describes CS lead and guidewire fracture 2 years after such an implant.
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