Implantation of Permanent Transvenous Atrial J Lead Using Lateral View Fluoroscopy

Bognolo, Diego A.; Vijayanagar, R; Eckstein, Paul F.; Pollicina, Federico; Rabow, Fred I.

doi:10.1016/s0003-4975(10)61352-5

Cited by 9 publications

(4 citation statements)

References 6 publications

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“…Most passive‐fixation atrial leads are manufactured with an inherent J shape to facilitate accurate deployment in the right atrial appendage while also ensuring good atrial myocardial contact 7,8 . The data from the present study show that leads whose J configuration has been lost and where the tip appears to be under strain with respect to the atrial wall (but which sense and pace adequately on the postoperative day) nonetheless have excellent long‐term stability and pacing parameters.…”

Section: Discussionmentioning

confidence: 78%

Permanent Pacemakers:

Hildick‐Smith

Satchithananda

Grace

et al. 2003

Pacing Clinical Electrophis

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The aim of this study was to assess if atrial leads whose "J" configuration has straightened significantly on the postprocedural chest X ray should be repositioned. Between January 1996 and December 1997, 445 patients underwent dual chamber pacemaker implantation at the Papworth Hospital. Postprocedural chest X rays were available in 410 of these. The degree of straightening of the tip of the atrial lead was assessed from the lateral chest X ray and was graded as mild (-10 to +10 degrees from the horizontal), moderate (+10 to +30 degrees), or severe (> or = +30 degrees). Patients were followed with regard to atrial sensing and pacing characteristics, lead displacements, and lead revisions. Fifty-two (12%) patients had some degree of straightening (graded mild, moderate, severe) of the atrial lead on the postprocedure chest X ray (passive fixation in 48, active 4). Of these, 12 patients underwent next day lead repositioning, 5 of whom had abnormalities of pacing and/or sensing parameters. Seven patients therefore underwent repositioning of the atrial lead despite normal pacing parameters in view of lead straightening alone. Of the 12 patients who underwent repositioning, 3 still had lead straightening after the second procedure. The cohort for follow-up consisted of 43 patients (24 [56%] men, age 69 +/- 11 years at the time of implant) who were left with significant atrial lead straightening but adequate atrial parameters. Straightening was mild in 26 patients, moderate in 10, and severe in 7 patients. At implant the P wave amplitude was 4.8 +/- 2.4 mV. Follow-up was for 4.8 +/- 2.1 years, a total of 178 patient years. At final follow-up, the P wave amplitude was 2.7 +/- 1.3 (P < 0.05 vs implant). Censoring events occurred in 16 cases, comprising 11 deaths (none suspected to be pacemaker or lead related), 3 cases of persistent atrial fibrillation, 1 system extraction for infection, and 1 lead extraction for erosion. There were no cases of inadequate atrial lead sensing or pacing in the remaining patients. Irrespective of the degree of lead straightening on the postoperative lateral chest X ray, atrial leads should not be repositioned unless there are abnormalities of pacing or sensing parameters.

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Section: Discussionmentioning

confidence: 78%

Permanent Pacemakers:

Hildick‐Smith

Satchithananda

Grace

et al. 2003

Pacing Clinical Electrophis

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“…18-50). 91,92 In the lateral projection, the tip should be anterior and observed to "bob" up and down. With the firmly seated tip in the atrial appendage, the lead body should be twisted or torqued to the left and right to establish a position of neutral torque.…”

Section: Placement Of Atrial Electrodesmentioning

confidence: 99%

Permanent Pacemaker and Implantable Cardioverter-Defibrillator Implantation

Belott¹,

Reynolds²

2007

Clinical Cardiac Pacing, Defibrillation, and Resynchronization Therapy

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“…Good atrial positioning consists of a generous J loop, with the tip moving from medial to lateral in a to-and-fro manner in the PA radiographic projection 95,96 (Fig. This lead type is generally easier to work with because the problem of helix hangup is avoided.…”

mentioning

confidence: 99%