A comparison between passive and active fixation leads in the coronary sinus for biatrial pacing Initial experience

Levy, Terry

doi:10.1053/eupc.2000.0105

Cited by 17 publications

(16 citation statements)

References 3 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The present study also reports the possibility of using active-fixation leads in the proximal CS and this confirms the work of Levy et al 11 There is a sleeve of atrial myocardium surrounding the proximal CS but there has been concern that the use of active-fixation leads in the CS carried an unacceptably high risk of cardiac perforation.…”

Section: Discussionsupporting

confidence: 91%

Left Atrial Vein Pacing:

Birnie

Connors

Veinot

et al. 2004

Pacing Clinical Electrophis

View full text Add to dashboard Cite

Biatrial pacing is a promising new therapy for drug refractory AF. This article reports two studies. First, an initial 14-patient experience with a novel technique for biatrial pacing. The authors attempted to pace from the LA vein branches of the proximal CS for LA stimulation. LA vein pacing would potentially offer the advantages of greater interatrial synchronization and possibly greater reduction in AF burden and also of lesser far-field R wave sensing and greater lead stability. Second, a postmortem series examining the number, size, and site of LA veins draining into the proximal CS is described. LA vein pacing was successful in 9 of 14 patients. LA vein electrode parameters have been stable during a median follow-up of 580 days. There were three early lead dislodgments but no other complications. In the second study, a postmortem analysis of 43 human hearts was performed. The study found that 38 (88.4%) of 43 hearts had at least one LA vein draining into the proximal 5 cm of the CS. In addition, 81.2% (33/43) had at least one vein greater than 4 Fr caliber. Thus, pacing in a greater proportion of patients might be achieved by the development and use of smaller (3, 4, and 5 Fr) electrodes. Furthermore, these smaller leads would obviously allow deeper advancement into the LA veins with the potential advantages of greater interatrial synchronization and lead stability and lesser far-field R wave sensing.

show abstract

Section: Discussionsupporting

confidence: 91%

Left Atrial Vein Pacing:

Birnie

Connors

Veinot

et al. 2004

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

“…5 Patients receiving cardiac resynchronization therapy (CRT) who have delayed LA activation are another group that might benefit from pacing the RA and mid to distal CS to ensure the LA contracts before mitral valve closure. 6 In the process of attempting to evaluate simultaneous pacing of the RA and mid to distal CS in CRT we found it difficult to reliably pace the mid to distal CS with the Attain 2188 (Medtronic, Inc., Minneapolis, MN, USA) or the Attain 4194 (Medtronic, Inc.); we encountered high thresholds and lead dislodgement similar to that reported by Levy et al 4 We did not attempt the use of active fixation leads. In one patient, after multiple unsuccessfully attempts to obtain a threshold of ,4 V, we prolapsed an Attain 4194 lead into the CS resulting in stable lead position and a threshold of 1.6 V. We subsequently developed a method for quickly delivering the prolapsed doublecanted bipolar lead to the CS.…”

Section: Introductionmentioning

confidence: 70%

“…4 Prolapsing the lead into the CS eliminates dislodgement. We did not systematically compare pacing thresholds with the lead tip first vs. prolapsed, but in the first case we only achieved acceptable thresholds after lead prolapse.…”

Section: Discussionmentioning

confidence: 99%

“…Unfortunately, it is difficult to obtain adequate thresholds with passive fixation leads in the mid to distal CS and once placed they dislodge in up to 42% 4 of implants. Levy et al 4 reported success with active fixation but many physicians are reluctant to use screw in leads in the CS. As a result, the majority of biatrial studies report pacing the RA and ostium (os) of the CS or two sites in the RA.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Prolapsed double-canted bipolar left ventricular lead for pacing the left atrium via the coronary sinus: experience in 11 patients

Worley

Gohn

2011

Europace

View full text Add to dashboard Cite

AimsHigh thresholds and frequent lead dislodgement limit pacing the left atrium (LA) from the mid to distal coronary sinus (CS). The aim of this report is to describe a method for and the results of prolapsing a double-canted bipolar lead into the mid-to-distal CS to eliminate lead dislodgement and improve pacing thresholds. Methods and resultsAfter CS access the 9 Fr. anatomic sheath is withdrawn to the right atrium (RA) over an extra support wire. A double-canted bipolar lead is advanced into the RA until the proximal bend is outside the tip of the sheath. With the stylet withdrawn to the proximal bend, the sheath and lead are advanced over the wire back into the CS. The lead distal to the proximal bend is prolapsed beside the sheath as the tip of the sheath enters the CS. The lead was successfully prolapsed in 11 consecutive patients. In one patient, capture was .5 V in all locations. Of the 10 successful implants, the acute thresholds were: mean 1.53 V, median 1.35 V, range 0.4 -4.0 V. Chronic thresholds were: mean 2 V, median 2 V range 0.4 -4.0 V. There were no displaced leads or lead fractures through 6 -10 months of follow-up. ConclusionsProlapse of a commercially available double-canted bipolar passive fixation lead eliminates lead dislodgment and improves thresholds providing a means for permanent pacing of the LA from the mid to distal CS and provides the design principles for a dedicated lead.--

show abstract

“…In view of the difficulties with stable proximal CV lead fixation, we decided to resort to active fixation leads when leads had to be placed proximally. Even before CV lead implantation became the standard in CRT, French work groups used screw‐in leads in the coronary sinus for biatrial pacing if no other leads could be kept in a stable position 26–28 . Pacing requires consistent electrical contact between cathode and myocardium.…”

Section: Active Lead Fixation Inside the Coronary Venous Systemmentioning

confidence: 99%

Implantation of Active Fixation Leads in Coronary Veins for Left Ventricular Stimulation: Report of Five Cases

Hansky

Vogt

Gueldner

et al. 2007

Pacing Clinical Electrophis

View full text Add to dashboard Cite

show abstract

A comparison between passive and active fixation leads in the coronary sinus for biatrial pacing Initial experience

Abstract: Active fixation leads can safely be used for left atrial pacing via the CS with good long-term pacing thresholds and stability.

Cited by 17 publications

References 3 publications

Left Atrial Vein Pacing:

Left Atrial Vein Pacing:

Prolapsed double-canted bipolar left ventricular lead for pacing the left atrium via the coronary sinus: experience in 11 patients

Implantation of Active Fixation Leads in Coronary Veins for Left Ventricular Stimulation: Report of Five Cases

Contact Info

Product

Resources

About