Left Atrial Vein Pacing:

Abstract

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.

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

“…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.…”

“…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][27][28] Pacing requires consistent electrical contact between cathode and myocardium. We observed that up to 45% of the venous circumference is in direct proximity to the myocardium; the remainder faces the pericardium (Fig.…”