Chronic Performance of Standard Pacing Leads Placed in the Coronary Sinus: An Answer to Chronic Pacing for Diastolic Heart Failure?

Abstract

Introduction: Stability of traditional bradycardia pacing leads (TPL) in the right atria and ventricle has been well established. Left ventricle pacing utilizing branches of the coronary sinus (CS) and is also well established with specifically designed leads. Recent data suggests pacing the left atria (LA) may be desired and beneficial to treating patients with HFpEF and intra-atrial conduction delays 1,2,3 These studies utilized TPL screwed into the CS for stability. 1 Adaptations to other left ventricular leads such as prolapsing has also been suggested. 4 We evaluated pacing the LA via TPL implanted into the body of the CS without active fixation or prolapse. Methods: Retrospective chart review of patients implanted with TPL leads to stimulate the LA were included. TPL were placed into the CS without helix extension with Y-connection to the RA lead (Bi-Atrial). Review and examination of digital X-rays were also analyzed to determine system type, lead position, and any system or lead changes over time. Results: N=74 patients were included (47M:27F) aged 79.7(+/-11.8). Implant to last follow-up ranged from 0.12 to 12.4 years (mean 3.16 +/-13.3). TPL-CS placement was divided into the proximal, mid, and distal portions consisting of n=8(10.8%), n=30(40.5%), and n=36(48.6%) respectively. N=14(18.9%) were part of Bi-A/Bi-Ventricular pacing system and the remaining were Bi-A only systems. N=3 (4%) infections and N=3 (4%) dislodgements occurred in all reviewed patients. Conclusions: In our analysis, TPL leads remained stable in the CS body with similar complication rates to TPL in traditional locations in the heart with fixation. As these leads were utilized with additional components, larger prospective studies may better analyze these findings. In addition, utilizing this technique with outcome data may provide further information for treatment of patients with HFpEF and intra-atrial delays.Introduction: Post cardiac transplant outcomes of patients supported with the Heartmate 3 left ventricular assist device (LVAD) have not been previously reported. The purpose of this analysis was to report status at the time of transplant and survival by continuous flow (CF) device type. Hypothesis: Patients supported with a HeartMate 3 LVAD will have a similar post-transplant survival to other contemporary CF-LVADs. Methods: The study cohort included adult patients supported on contemporary, continuous flow (CF) devices in the UNOS registry who underwent cardiac transplant between the years 2014-2018, prior to the 2018 UNOS allocation system change. The analysis was limited to patients who underwent initial LVAD implantation in 2014 and beyond to allow post-transplant comparisons among patients with similar LVAD support times. Multivariable cox regression was performed to assess the association between LVAD type and post-transplant survival. Results: The study cohort consisted of 3,117 patients who underwent cardiac transplant while on LVAD support (Heartmate 2: 1,545, Heartmate 3: 179, HeartWare (HVAD): 1,393). No patients su...

Interatrial conduction block–related atrioventricular dyssynchrony treated with dual-site atrial pacing

“…There are several techniques to perform left atrial pacing instead of septal pacing, including active or passive fixation within the main body of the CS, prolapse of a canted left ventricular lead, or wedging a lead into the vein of Marshall. [9][10][11][12][13] These techniques are complex and can be associated with high thresholds and dislodgements (up to 42% with passive leads). 10 We found that pacing the interatrial septum in this case was easily facilitated by use of a dedicated sheath that directs the lead to the septum.…”