Initial Clinical Experience with a New Self‐Retaining Left Ventricular Lead for Permanent Left Ventricular Pacing

Abstract

This study evaluated the performance of a new lead for permanent left ven tricular (LV) pacing via the coronary sinus (CS) in four men and nine women (mean age = 71 ±13 years) with sick sinus syndrome. It consists of a unipolar ventricular lead with a distal portion preshaped in an S curve to provide steerability and stability within the CS. Its efficacy and stability for per manent LV pacing were tested at implant, predischarge, and at 1, 3 and 6 months of follow-up. The lead was successfully implanted in 11/13 patients (85%) within a mean fluoroscopy time of 35 ± 22 minutes. The final positions of the electrodes at the tip of the lead within venous tributaries of the CS were: (1) an terior (n = 2, 18%); (2) posterolateral (n = 5, 45%); and (3) the lateral (n = 4, 36%). Unsuccessful implants were due to unstable lead position (n = 1), or high pacing threshold (n = 1). There was no postprocedural lead dislodgment or significant changes in the R wave amplitude, LV pacing threshold and lead impedance up to 6 months of follow-up. In summary, this initial experience suggests that this new lead offers safe and reliable permanent LV pacing via the CS in the majority of patients and may be used in isolation or in con junction with right ventricular pacing for biventricular synchronization. (PACE 2000; 23[Pt. II] :1738-1740 left ventricular pacing, heart failure, ventricular synchronization, pacemaker lead

Effect of Percutaneous Interventions within the Coronary Sinus on the Success Rate of the Implantations of Resynchronization Pacemakers

“…Over 5% of all CRT candidates cannot be treated using this method because of the inability to implant LV lead into a proper vessel or because of a late dislocation of electrode 1–5 . Furthermore, the inability to reach a stable position of the lead within the branch of the coronary sinus (CS) during implantation has been also reported as one of the reasons for the failure of this procedure 6 . The only option for CRT in this group of patients is surgical epicardial LV implant.…”

“…[1][2][3][4][5] Furthermore, the inability to reach a stable position of the lead within the branch of the coronary sinus (CS) during implantation has been also reported as one of the reasons for the failure of this procedure. 6 The only option for CRT in this group of patients is surgical epicardial LV implant.…”

Heart Failure and Pulmonary Embolism:

“…This is an atypical dislodgement since usual LV lead dislodgements result in the lead moving few centimeters forward or backward in the hours(S) to days following implantation. Even though lead dislodgment is among the most common complications of pacemaker implantations, these unusual features in our patient have not been described in the literature 1,2 …”

Cardiac resynchronization therapy

“…The Multisite Stimulation in Cardiomyopathy (MUS-TIC) study was the first multicenter randomized, cross- over, single-blind study of biventricular pacing for NYHA class III patients with sinus rhythm, QRS interval, >150 ms, LVEF of <35%, and LVEDD of >60 mm [18,22,23]. All patients received transvenous LV pacing with a biventricular pacing system.…”

“…According to another technique the CS is entered using a conventional electrophysiology catheter, and then the guiding sheath is tracked through it into the CS. Reported transvenous CRT success rates range between 85% and 93% [14,[16][17][18]. Adequate venographic technique consists of acquiring and storing images in at least two radiographic planes to provide the optimal anatomic roadmap for lead placement.…”