N.-phrenicus-Stimulation bei biventrikulären Schrittmachern

Schwierz, Thomas; Winter, Siegmund; Pürerfellner, Helmut; Tomaselli, Florian; Nesser, Hans Joachim; Függer, R.

doi:10.1007/s00104-007-1368-7

Cited by 4 publications

(2 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thus, selecting a CRT device featuring cathode programmability should be the first step in implantation to minimize the risk of PS, whereas lead repositioning should be performed as the last resort. 18 We observed that PS evaluation at implantation is not 100% predictive, owing to the body position (detected only after implantation in 27 patients), a fact that reinforces the need for cathode programmability. Automatic verification of capture helped to manage 4 patients who had a difference in PS-LV threshold of Յ2 V and may be considered as complementary to cathode programmability in this instance.…”

Section: Response To Crt and Ps Managementmentioning

confidence: 69%

Phrenic Stimulation

Biffi

Moschini

Bertini

et al. 2009

Circ: Arrhythmia and Electrophysiology

115

View full text Add to dashboard Cite

Background-Phrenic stimulation (PS) may hinder left ventricular (LV) pacing. We prospectively observed its prevalence in consecutive patients with cardiac resynchronization therapy (CRT) devices. Methods and Results-In the years 2003 to 2006, 197 patients received a CRT device. PS and LV threshold measurements were carried out at implantation and at 6-month follow-up. LV reverse remodeling was assessed by echocardiography before implantation and at follow-up. LV lead placement was lateral/posterolateral in 86% of patients. Both PS and LV reverse remodeling occurred most frequently at the lateral/posterolateral LV pacing sites (PϽ0.001). PS was detected in 73 (37%) of patients and was clinically relevant in 41 (22%). The detection of PS at implantation had a poor sensitivity, as it occurred only in left lateral or sitting position in 27 patients. Ten patients (5%) underwent repeated surgery and 4 (2%) had their CRT turned off because of PS. At follow-up, we could manage PS noninvasively in 32 patients with a small PS-LV threshold difference: in 20 by cathode programmability (3 also thanks to automatic management of LV output) and in 12 (without cathode programmability) by programming the LV output as threshold ϩ1 V. Conclusions-PS may seriously hinder CRT. A bipolar LV lead and cathode programmability are mandatory to avoid PS by changing the LV pacing vector at target sites for CRT. LV stability at target sites despite PS should also be pursued by these means. The automatic adjustment of LV pacing output is complementary in patients with a small PS-LV threshold difference. (Circ Arrhythmia Electrophysiol. 2009;2:402-410.)

show abstract

Section: Response To Crt and Ps Managementmentioning

confidence: 69%

Phrenic Stimulation

Biffi

Moschini

Bertini

et al. 2009

Circ: Arrhythmia and Electrophysiology

115

View full text Add to dashboard Cite

show abstract

“…PNS is found in 13%-18% of CRT implantations, and it is one of the main reasons for intraoperative lead repositioning from an anatomically acceptable location. 18,19 Pacing with high energy during implantation may help to avoid subsequent PNS, but despite high-energy stimulation, intraoperative testing in a supine position cannot rule out later PNS in other body positions, 20 even if the electrode remains in the same place. In seven cases, a new, minimally invasive method was performed using an ablation catheter for repositioning of the lead via a femoral approach.…”

Section: Discussionmentioning

confidence: 99%

Long-term experience with coronary sinus side branch stenting to stabilize left ventricular electrode position

et al. 2011

View full text Add to dashboard Cite

BACKGROUND Despite technical advancements, implantation of coronary sinus (CS) leads may be challenging, and dislocation remains a relevant clinical problem.OBJECTIVE The aim of this study was to investigate the effectiveness, safety, and long-term outcome of stent implantation to anchor the lead to the wall of the CS side branch. METHODSStenting of a CS side branch was performed in 312 patients. The procedure was performed because of postoperative lead dislocation in 16 patients and because of an intraoperative unstable lead position or phrenic nerve stimulation in 296 cases. A bare metal coronary stent was introduced over a second guide wire in the same CS sheath. The stent was deposited 5-35 mm proximal to the most proximal electrode. Mechanical damage of the CS side branch or pericardial effusion was not observed owing to stenting. RESULTSDuring follow-up (median 28.4, interquartile range 15-37, maximum 70 months), a clinically important increase in the left ventricular pacing threshold was found in four cases and reoperation was necessary in only two patients (0.6%). Phrenic nerve stimulation was observed in 18 instances, and repositioning with an ablation catheter was performed in seven cases. Impedance measurements did not suggest lead insulation failure. Three stented leads were extracted without complication after 3-49 months owing to infection, while four leads were extracted easily during heart transplantation after 7-27 months.CONCLUSION Stent implantation to stabilize CS lead position seems to be an effective and safe procedure in prevention and treatment of CS lead dislocation in selected cases.KEYWORDS Cardiac resynchronization; LV lead implantation; Coronary sinus; Lead dislocation; Stent implantation ABBREVIATIONS CRT ϭ cardiac resynchronization therapy; CS ϭ coronary sinus; INR ϭ international normalized ratio; LV ϭ left ventricle; NYHA ϭ New York Heart Association; PNS ϭ phrenic nerve stimulation (Heart Rhythm 2011;8:845-850)

show abstract