Prolapsed double-canted bipolar left ventricular lead for pacing the left atrium via the coronary sinus: experience in 11 patients

Abstract

AimsHigh thresholds and frequent lead dislodgement limit pacing the left atrium (LA) from the mid to distal coronary sinus (CS). The aim of this report is to describe a method for and the results of prolapsing a double-canted bipolar lead into the mid-to-distal CS to eliminate lead dislodgement and improve pacing thresholds. Methods and resultsAfter CS access the 9 Fr. anatomic sheath is withdrawn to the right atrium (RA) over an extra support wire. A double-canted bipolar lead is advanced into the RA until the proximal bend is outside the tip of the sheath. With the stylet withdrawn to the proximal bend, the sheath and lead are advanced over the wire back into the CS. The lead distal to the proximal bend is prolapsed beside the sheath as the tip of the sheath enters the CS. The lead was successfully prolapsed in 11 consecutive patients. In one patient, capture was .5 V in all locations. Of the 10 successful implants, the acute thresholds were: mean 1.53 V, median 1.35 V, range 0.4 -4.0 V. Chronic thresholds were: mean 2 V, median 2 V range 0.4 -4.0 V. There were no displaced leads or lead fractures through 6 -10 months of follow-up. ConclusionsProlapse of a commercially available double-canted bipolar passive fixation lead eliminates lead dislodgment and improves thresholds providing a means for permanent pacing of the LA from the mid to distal CS and provides the design principles for a dedicated lead.--

Permanent left atrial pacing therapy may improve symptoms in heart failure patients with preserved ejection fraction and atrial dyssynchrony: a pilot study prior to a national clinical research programme

“…A new technique for pacing the CS with a bipolar passive fixation has recently been published. It could provide the design principles for a dedicated lead which might be of interest for future atrial pacing studies …”

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.…”