Synchronous Ventricular Pacing without Crossing the Tricuspid Valve or Entering the Coronary Sinus—Preliminary Results

Henz, Benhur D.; Friedman, Paul A.; Bruce, Charles J.; Okumura, Yasuo; Johnson, Brynte H.; Danielsen, Andrew J.; Packer, Douglas L.; Asirvatham, Samuel J.

doi:10.1111/j.1540-8167.2009.01556.x

Cited by 22 publications

(21 citation statements)

References 34 publications

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“…The absence of such data has contributed to disagreement about the location of DHBP leads with respect to the plane of the tricuspid valve. 1,2 We present an autopsy study of a patient who had previously had a DHBP lead implanted, showing unequivocally that the lead is implanted on the atrial side of the tricuspid annulus.…”

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confidence: 97%

Autopsy Analysis of the Implantation Site of a Permanent Selective Direct His Bundle Pacing Lead

Hardin

Crespo

et al. 2012

Circ: Arrhythmia and Electrophysiology

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T o date, there has not been direct visualization of the anatomic location of direct His bundle pacing (DHBP) leads in the human heart. The absence of such data has contributed to disagreement about the location of DHBP leads with respect to the plane of the tricuspid valve. 1,2 We present an autopsy study of a patient who had previously had a DHBP lead implanted, showing unequivocally that the lead is implanted on the atrial side of the tricuspid annulus.An 81-year-old man with diabetes died of sepsis secondary to a lower-extremity infection. Two years prior, the patient presented with symptoms of congestive heart failure and presyncope. He had a history of coronary artery bypass graft and myocardial infarction with mild to moderate left ventricular dysfunction (ejection fraction, 40%-45%). ␤-blockade therapy was limited by sinus bradycardia and frequent Wenckebach block. The patient was noninducible for ventricular arrhythmias, and a pacemaker was recommended for chronotropic incompetence and AV block. To prevent pacemaker-induced electric dyssynchrony, we implanted a DHBP lead.DHBP lead implantation was performed as previously described. 3 Briefly, an octapolar mapping catheter was Figure 1. Electrograms obtained at the time of lead implant. Shown from top to bottom are the surface ECG leads, the DHBP pacing lead bipolar electrogram, and the octapolar mapping catheter (HBD-distal electrode bipole to HB4 -proximal electrode bipole), respectively. Left panel: Sinus rhythm. A distinct His deflection is evident on the DHBP lead and distal octapolar bipolar electrograms (HV interval, 55 ms; QRS duration, 95 ms). The low-amplitude, but discrete His potential, on the DHBP lead is indicated by the arrow. This was the fifth site tested. It is not unusual to see the bipolar His potential diminish in stature on the DHBP lead, presumably because of tissue edema following multiple serial lead fixations. Right panel: Selective direct His bundle pacing. The stimulus-to-QRS interval is isoelectric in all surface leads and equals the HV interval (55 ms). The QRS duration is identical to the conducted QRS. The arrow indicates late septal activation following His Purkinje spread.

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confidence: 97%

Autopsy Analysis of the Implantation Site of a Permanent Selective Direct His Bundle Pacing Lead

Hardin

Crespo

et al. 2012

Circ: Arrhythmia and Electrophysiology

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“…LV pacing via the cardiac vein was attempted in patients after prosthetic TV implantation, which appeared effective; similar results were obtained in patients with defi brillator leads [14,15]. Positive effects of more synchronous ventricular pacing without crossing the TV may also be achieved through atrioventricular pacing as animal studies promisingly show [16].…”

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confidence: 71%

Lead dependent tricuspid dysfunction: Analysis of the mechanism and management in patients referred for transvenous lead extraction

Polewczyk

Kutarski²,

Tomaszewski³

et al. 2013

Cardiol J

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Background: Lead-dependent tricuspid dysfunction (LDTD) is one of important complications in patients with cardiac implantable electronic devices. However, this phenomenon is probably underestimated because of an improper interpretation of its clinical symptoms. The aim of this study was to identify LDTD mechanisms and management in patients referred I and II (91.7% vs. 94.2%; p = 0.6 and 100% vs. 98.4%; p = 0.46, respectively (Cardiol J 2013; 20, 4: 402-410)

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“…However, when mapping this region, because of the very large ventricular electrograms that are seen, it is probably assumed that the tricuspid valve already has been crossed and these signals and regions not included in a complete Koch's triangle map. 10 Similarly, the coronary sinus itself is an irregularly shaped, sloping, funnel-like structure. Should electrograms identified when mapping on this indistinct coronary sinus musculature near the roof be considered to be derived from Koch's triangle or not?…”

Section: Defining the Anatomymentioning

confidence: 99%

The “Slow Pathway” Potential: Fact or Fiction?

Gard

Asirvatham

2011

Circ: Arrhythmia and Electrophysiology

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Synchronous Ventricular Pacing without Crossing the Tricuspid Valve or Entering the Coronary Sinus—Preliminary Results

Abstract: The AVS was successfully paced in three dogs resulting in synchronous ventricular activation without crossing the TV.

Cited by 22 publications

References 34 publications

Autopsy Analysis of the Implantation Site of a Permanent Selective Direct His Bundle Pacing Lead

Autopsy Analysis of the Implantation Site of a Permanent Selective Direct His Bundle Pacing Lead

Lead dependent tricuspid dysfunction: Analysis of the mechanism and management in patients referred for transvenous lead extraction

The “Slow Pathway” Potential: Fact or Fiction?

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