Technological and Clinical Challenges in Lead Placement for Cardiac Rhythm Management Devices

Abstract

Cardiac Cardiac disease is a leading cause of death worldwide. Disturbance in the conduction system of the heart may trigger or aggravate heart dysfunction, affecting the efficiency of the heart, and lead to heart failure or cardiac arrest. Patients may require implantable cardiac rhythm management devices (ICRMDs) to maintain or restore the heart rhythm.ICRMDs have undergone important improvements, yet limitations still exist, presenting important technological challenges. Most ICRMDs consist of a subcutaneous control unit and intracardiac electrodes. The leads, which connect the electrodes to the control unit, are usually placed transvenously through the subclavian veins. Various locations inside the heart are used for placement of electrodes, depending on the specific condition. Some of the limitations to effective pacemaker therapy are associated with placement and location of the leads. Various approaches have been developed to overcome these challenges, such as multisite pacing and leadless solutions. This paper aims to review the state of the art for the selection of placement sites for pacemakers, implantable cardioverter defibrillator (ICD) and cardiac resynchronization therapy devices (CRT) devices and discuss potential technological advancements to improve the results of ICRMD-therapy including development av leadless technology.

Regional Left Ventricular Fiber Stress Analysis for Cardiac Resynchronization Therapy Response

“…The CRT outcome is largely dependent on the positioning of the pacing electrodes. 2 , 3 Using repeated measurements of SD_MVC may be important to define an optimal pacing site. Reducing SD_MVC is likely to lead to the reversal of the pathogenic mechanisms thereby causing reverse remodeling and potentially improving the clinical syndrome of heart failure.…”

Evaluation of Secrecy Capacity for Next-Generation Leadless Cardiac Pacemakers

“…These leads contain electrodes to the distal ends that sense irregularities and provides electric excitation to maintain proper heart rhythm. Depending on the specific cardio-pathology, the electrodes can lie in the right ventricle, right atrium or in the coronary sinus above the left ventricle [2] . The transvenous leads are considered to be the weak side of a traditional pacemaker system because they can fracture, they may lead to infection, and also their explantation carries significant risk of mortality [3], [4].…”

Optimal pacing sites in cardiac resynchronization by left ventricular activation front analysis

“…Cardiac Resynchronization Therapy (CRT) may improve pumping mechanism and HF symptoms for such patients (3,4) , however about 30 % of patients selected according to international guidelines do not respond to CRT (4,5) . In a subset of patients, non-response can be explained by suboptimal activation of the left ventricle (LV) (6) . Strategies for selection of pacing sites using preoperative or acute clinical parameters have been disappointing (7) and multicentre trials have not provided specific or sensitive response-related acute factors predicting results from CRT (8) , nor provided evidence of an optimal pacing configuration (8,9) .…”