Stimulation of the left ventricle through the coronary sinus with a newly developed ‘over the wire’ lead system — early experiences with lead handling and positioning

Abstract

The new 'over the wire' lead and guiding catheter system allows uncomplicated access to the coronary sinus and the depth of the coronary vein tributaries. Left ventricular sensing and pacing thresholds are acceptable for chronic use in implanted cardiac rhythm management systems.

Left Ventricular Lead Performance in Cardiac Resynchronization Therapy: Impact of Lead Localization and Complications

“…The LV stimulation threshold was unrelated to whether the LV pacing site was anterior or posterior/posteolateral acutely during follow‐up. Other studies support our findings with the highest LV stimulation thresholds in the basal or mid‐ventricular region of the lateral/posteolateral area of the LV 2,3 . In contrast, a study by Walker et al with 49 patients showed the lowest stimulation values in the basal region 4 .…”

“…R wave amplitude showed the best value at apical positions and this is supported by a prior study reported by Sack et al (NS) 2 . In contrast to Sack et al, we found significant better values for R wave amplitude in lateral/posteolateral positions (Group B) compared to anterior positions (Group A).…”

“…In the RAO view, the distance from the coronary sinus/mitral plane to the tip of a pacing electrode is easily measured and this adds the third dimension to the exact description of the localization of the LV pacing site. In patients with LV pacing site after 3 o'clock in LAO view, the LV can be divided into three segments in the RAO view: basal, mid‐ventricular, and apical 2–4 …”

Tratamiento de la insuficiencia cardíaca avanzada mediante estimulación biventricular. Experiencia inicial en una serie de 22 casos consecutivos

“…Los implantes realizados en pacientes con cardiopatía isquémica fueron más prolongados y tuvieron umbrales de estimulación ventricular izquierda mayores, reflejando una mayor dificultad técnica probablemente provocada por la existencia de áreas de miocardio necrosado e inexcitable. Desde nuestro punto de vista, en estos casos los sistemas de electrodo coaxial con guía de 0,014" son extremadamente útiles al permitir cartografiar múltiples zonas de miocardio y facilitar el desplazamiento por el sistema venoso cardíaco con relativa facilidad 20,21 . En nuestro estudio, el relativamente escaso número de pacientes y la subjetividad de algunas de las variables clínicas analizadas (clase funcional, número de ingresos), así como el propio diseño del trabajo, no permiten concluir inequívocamente que el beneficio clínico observado sea debido a la terapia.…”

Intravascular Lead Extractions: Tips and Tricks

“…According to several studies, the procedure is usually time consuming with long fluoroscopy times and the implantation success rate is reduced compared to conventional procedures (estimated between 90% to 97%) [52][53][54][55][56]. With the introduction of special delivery sheaths and the so-called 'over the wire technology' the breakthrough of LV pacing became reality in the early 2000s, yet lead stability remains problematic mainly due to different coronary sinus anatomies [57][58]. Because no muscular trabeculae is found in the CS for anchoring of the lead, the tip has to be pushed as distal as possible in a wedge position in a lateral or a postero-lateral CS branch and is typically non-actively fixated.…”