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Isonaga Y, Inamura Y, Sato A, Inaba O, Goya M, Sasano T. Challenging lead extraction with quadripolar active fixation of coronary sinus with severe adhesion. HeartRhythm Case Rep 2023; 9:614-617. [PMID: 37746564 PMCID: PMC10511931 DOI: 10.1016/j.hrcr.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Affiliation(s)
- Yuhei Isonaga
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Yukihiro Inamura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Akira Sato
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Masahiko Goya
- Cardiovascular Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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2
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Robertson C, Duffey O, Tang P, Fairhurst N, Monteiro C, Green P, Grogono J, Davies M, Lewis A, Wijesurendra R, Ormerod J, Gamble J, Ginks M, Rajappan K, Bashir Y, Betts TR, Herring N. An active fixation quadripolar left ventricular lead for cardiac resynchronization therapy with reduced postoperative complication rates. J Cardiovasc Electrophysiol 2022; 33:458-463. [PMID: 34968010 PMCID: PMC9304298 DOI: 10.1111/jce.15346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The rate of left ventricular (LV) lead displacement after cardiac resynchronization therapy (CRT) remains high despite improvements in lead technology. In 2017, a novel quadripolar lead with active fixation technology became available in the UK. METHODS This was a retrospective, observational study analyzing device complications in 476 consecutive patients undergoing successful first-time implantation of a CRT device at a tertiary center from 2017 to 2020. RESULTS Both active (n = 135) and passive fixation (n = 341) quadripolar leads had similar success rates for implantation (99.3% vs. 98.8%, p = 1.00), although the pacing threshold (0.89 [0.60-1.25] vs. 1.00 [0.70-1.60] V, p = .01) and lead impedance (632 [552-794] vs. 730 [636-862] Ohms, p < .0001) were significantly lower for the active fixation lead. Patients receiving an active fixation lead had a reduced incidence of lead displacement at 6 months (0.74% vs. 4.69%, p = .036). There was no significant difference in the rate of right atrial (RA) and right ventricular (RV) lead displacement between the two groups (RA: 1.48% vs. 1.17%, p = .68; RV: 2.22% vs. 1.76%, p = .72). Reprogramming the LV lead after displacement was unsuccessful in most cases (successful reprogramming: Active fix = 0/1, Passive fix = 1/16) therefore nearly all patients required a repeat procedure. As a result, the rate of intervention within 6 months for lead displacement was significantly lower when patients were implanted with the active fixation lead (0.74% vs. 4.40%, p = .049). CONCLUSION The novel active fixation lead in our study has a lower incidence of lead displacement and re-intervention compared to conventional quadripolar leads for CRT.
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Affiliation(s)
- Calum Robertson
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
- Department of Physiology Anatomy and Genetics, Burdon Sanderson Cardiac Science CentreUniversity of OxfordOxfordUK
| | - Owen Duffey
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
- Department of Physiology Anatomy and Genetics, Burdon Sanderson Cardiac Science CentreUniversity of OxfordOxfordUK
| | - Pok‐Tin Tang
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Natalie Fairhurst
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Cristiana Monteiro
- Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Peregrine Green
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
- Department of Physiology Anatomy and Genetics, Burdon Sanderson Cardiac Science CentreUniversity of OxfordOxfordUK
- Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Joanna Grogono
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
- Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Mark Davies
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Andrew Lewis
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
- Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Rohan Wijesurendra
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
- Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Julian Ormerod
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - James Gamble
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Matthew Ginks
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Kim Rajappan
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Yaver Bashir
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
| | - Tim R. Betts
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
- Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
| | - Neil Herring
- Department of CardiologyOxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation TrustOxfordUK
- Department of Physiology Anatomy and Genetics, Burdon Sanderson Cardiac Science CentreUniversity of OxfordOxfordUK
- Division of Cardiovascular Medicine, Radcliffe Department of MedicineUniversity of OxfordOxfordUK
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3
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Schiedat F, Bogossian H, Schöne D, Aweimer A, Patsalis PC, Hanefeld C, Mügge A, Kloppe A. Long-Term Performance Comparison of Bipolar Active vs. Quadripolar Passive Fixation Leads in Cardiac Resynchronisation Therapy. Front Cardiovasc Med 2021; 8:734666. [PMID: 34881300 PMCID: PMC8645570 DOI: 10.3389/fcvm.2021.734666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Bipolar active fixation (BipolarAFL) and quadripolar passive fixation left-ventricular leads (QuadPFL) have been designed to reduce the risk of phrenic nerve stimulation (PNS), enable targeted left-ventricular pacing, and overcome problems of difficult coronary venous anatomy and lead dislodgment. This study sought to report the long-term safety and performance of a BipolarAFL, Medtronic Attain Stability 20066, compared to QuadPFL. Methods: We performed a single-operator retrospective analysis of 81 patients receiving cardiac resynchronization therapy (CRT) (36 BipolarAFL, 45 QuadPFL). Immediate implant data and electrical and clinical data during follow-up (FU) were analyzed. Results: BipolarAFL has been chosen in patients with significantly larger estimated vein diameter (at the lead tip: 7.2 ± 4.1 Fr vs. 4.1 ± 2.3 Fr, p < 0.001) without significant time difference until the final lead position was achieved (BipolarAFL: 20.9 ± 10.5 min, vs. QuadPFL: 18.9 ± 8.9 min, p = 0.35). At 12 month FU no difference in response rate to CRT was recorded between BipolarAFL and QuadPFL according to left ventricular end-systolic volume (61.1 vs. 60.0%, p = 0.82) and New York Heart Association (66.7 vs. 62.2%, p = 0.32). At median FU of 48 months (IQR: 44-54), no lead dislodgment occurred in both groups but a significantly higher proportion of PNS was recorded in QuadPFL (13 vs. 0%, p < 0.05). Electrical parameters were stable during FU in both groups without significant differences. Conclusion: BipolarAFL can be implanted with ease in challenging coronary venous anatomy, shows excellent electrical performance and no difference in clinical outcome compared to QuadPFL.
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Affiliation(s)
- Fabian Schiedat
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, Bochum, Germany.,Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | | | - Dominik Schöne
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - Assem Aweimer
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, Bochum, Germany
| | - Polykarpos C Patsalis
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, Bochum, Germany
| | - Christoph Hanefeld
- Department of Internal Medicine at Elisabeth Krankenhaus Bochum of the Ruhr University Bochum, Bochum, Germany
| | - Andreas Mügge
- Department of Cardiology and Angiology at University Hospital Bergmannsheil Bochum of the Ruhr-University Bochum, Bochum, Germany
| | - Axel Kloppe
- Department of Cardiology and Angiology at Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
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Keiler J, Meinel FG, Ortak J, Weber MA, Wree A, Streckenbach F. Morphometric Characterization of Human Coronary Veins and Subvenous Epicardial Adipose Tissue-Implications for Cardiac Resynchronization Therapy Leads. Front Cardiovasc Med 2021; 7:611160. [PMID: 33426007 PMCID: PMC7793918 DOI: 10.3389/fcvm.2020.611160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/16/2020] [Indexed: 11/13/2022] Open
Abstract
Subvenous epicardial fat tissue (SEAT), which acts as an electrical insulation, and the venous diameter (VD) both constitute histomorphological challenges for optimal application and lead design in cardiac synchronization therapy (CRT). In this study, we characterized the morphology of human coronary veins to improve the technical design of future CRT systems and to optimize the application of CRT leads. We retrospectively analyzed data from cardiac computed tomography (CT) of 53 patients and did studies of 14 human hearts using the postmortem freeze section technique and micro CT. Morphometric parameters (tributary distances, offspring angles, luminal VD, and SEAT thickness) were assessed. The left posterior ventricular vein (VVSP) had a mean proximal VD of 4.0 ± 1.4 mm, the left marginal vein (VMS) of 3.2 ± 1.5 mm and the anterior interventricular vein (VIA) of 3.9 ± 1.3 mm. More distally (5 cm), VDs decreased to 2.4 ± 0.6 mm, 2.3 ± 0.7 mm, and 2.4 ± 0.6 mm, respectively. In their proximal portions (15 mm), veins possessed mean SEAT thicknesses of 3.2 ± 2.4 (VVSP), 3.4 ± 2.4 mm (VMS), and 4.2 ± 2.8 mm (VIA), respectively. More distally (20-70 mm), mean SEAT thicknesses decreased to alternating low levels of 1.3 ± 1.1 mm (VVSP), 1.7 ± 1.1 mm (VMS), and 4.3 ± 2.6 mm (VIA), respectively. In contrast to the VD, SEAT thicknesses alternated along the further distal vein course and did not display a continuous decrease. Besides the CRT responsiveness of different areas of the LV myocardium, SEAT is a relevant electrophysiological factor in CRT, potentially interfering with sensing and pacing. A sufficient VD is crucial for successful CRT lead placement. Measurements revealed a trend toward greater SEAT thickness for the VIA compared to VVSP and VMS, suggesting a superior signal-to-noise-ratio in VVSP and VMS.
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Affiliation(s)
- Jonas Keiler
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Felix G Meinel
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Jasmin Ortak
- Rhythmology and Clinical Electrophysiology, Divisions of Cardiology, Rostock University Medical Center, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Andreas Wree
- Department of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Felix Streckenbach
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany.,Center for Transdisciplinary Neurosciences Rostock (CTNR), Rostock University Medical Center, Rostock, Germany
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5
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Guella E, Brack M, Abozguia K, Cassidy CJ. First experience in quadripolar active fixation coronary sinus lead extraction: a case report. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 33426434 PMCID: PMC7780495 DOI: 10.1093/ehjcr/ytaa184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/27/2020] [Accepted: 05/29/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The Attain Stability Quadripolar 4798 lead is a relatively new quadripolar active fixation coronary sinus (CS) lead. No cases of extraction of a chronically implanted 4798 lead have been published to date. CASE SUMMARY A 52-year-old man with a history of previous cardiac resynchronization therapy pacemaker (CRT-P) insertion and atrioventricular node ablation presented to our institution with a pocket infection 69 weeks after implantation. Directed intravenous antibiotic therapy was commenced and an extraction was performed the following day. Extraction of the right atrial and right ventricular leads was simple and achieved with gentle manual traction. Extraction of the CS lead was more difficult. Significant traction was required due to the formation of adhesions inside the CS but extraction of the lead was eventually successful without complication. Specialized extraction equipment was not required. A new contralateral CRT-P device was implanted, and the patient was discharged home. He remains well at 3 months of follow-up. DISCUSSION We present the first case of extraction of a chronically implanted active fixation Attain Stability Quadripolar lead. Our experience demonstrates that this has been performed successfully without specialist tools and with preservation of the CS branch. Significant adhesion was noted at the site of active fixation, however. Potential difficulty with this lead's extraction should therefore be considered when contemplating its use.
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Affiliation(s)
- Elhosseyn Guella
- Cardiology Department, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire FY3 8NR, UK
| | - Michael Brack
- Cardiology Department, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire FY3 8NR, UK
| | - Khalid Abozguia
- Cardiology Department, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire FY3 8NR, UK
| | - Christopher John Cassidy
- Cardiology Department, Lancashire Cardiac Centre, Blackpool Victoria Hospital, Whinney Heys Road, Blackpool, Lancashire FY3 8NR, UK
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6
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Gerontitis D, Diab I, Chow AWC, Hunter RJ, Leyva F, Turley AJ, Williams I, Ullah W. UK multicenter retrospective comparison of novel active versus conventional passive fixation coronary sinus leads. J Cardiovasc Electrophysiol 2020; 31:2948-2953. [PMID: 32716096 DOI: 10.1111/jce.14694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/11/2020] [Accepted: 07/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND A novel active fixation coronary sinus (CS) lead, Attain Stability (AS), has been released aiming to improve targeted lead positioning. Rather than being wedged into the distal vessel, it relies on a side helix for fixation. We aimed to compare implant procedure parameters and electromechanical stability of the AS lead with passive CS leads. METHODS A retrospective study involving six major UK cardiac centers. Patients who received active fixation leads were compared with passive fixation lead recipients in a 1:2 ratio. The primary outcome was total lead displacements (combined macrodisplacement/microdisplacement, defined as displacements requiring repositioning procedures, an increase in threshold ≥0.5 V or pulse width ≥0.5 ms, or a change in pacing polarity). RESULTS A total of 761 patients were included (253 AS leads and 508 passive fixation leads), of which 736 had follow-up data. The primary endpoint rate was 31% (75/241) in the active and 43% (214/495) in the passive group (p = .002). Six patients (2.5%) in the active group and 14 patients (2.8%) in the passive group required CS lead repositioning procedures (p = 0.981). On multivariable analysis, active leads were associated with a reduction in lead displacements, odds ratio 0.66 (95% confidence interval: 0.46-0.95), p = .024. There were differences in favor of passive leads in procedure duration, 120 (96-149) versus 127 (105-155) min (p = .008), and fluoroscopy time, 17 (11-26) versus 18.5 (13-27) min (p = .0022). The median follow-up duration was similar (active vs. passive): 31 (17-47) versus 34 (16-71) weeks, (p = .052). CONCLUSION AS CS leads had improved electromechanical stability compared with passive fixation leads, with only minimal increases in implant procedure and fluoroscopy times.
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Affiliation(s)
- Dimitrios Gerontitis
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ihab Diab
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Anthony W C Chow
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Ross J Hunter
- Department of Arrhythmia Services, Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Francisco Leyva
- Aston Medical Research Institute, Aston Medical School, Aston University, Birmingham, UK
| | - Andrew J Turley
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | - Ian Williams
- Department of Cardiology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Waqas Ullah
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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7
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Jackson KP, Faerestrand S, Philippon F, Yee R, Kong MH, Kloppe A, Bongiorni MG, Lee SF, Canby RC, Pouliot E, van Ginneken MME, Crossley GH. Performance of a novel active fixation quadripolar left ventricular lead for cardiac resynchronization therapy: Attain Stability Quad Clinical Study results. J Cardiovasc Electrophysiol 2020; 31:1147-1154. [PMID: 32162757 DOI: 10.1111/jce.14439] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/01/2020] [Accepted: 03/04/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Medtronic Attain Stability Quad lead is a quadripolar left ventricular (LV) lead with an active fixation helix assembly designed to fixate the lead within the coronary sinus and pace nonapical regions of the LV. The primary objective of this study was to determine the safety and effectiveness of this novel active fixation quadripolar LV lead. METHODS Patients with standard indications for cardiac resynchronization therapy (CRT) were enrolled. All patients were followed at 3 and 6 months post-implant and every 6 months thereafter until study closure. Pacing capture thresholds (PCTs) were measured at implant and each follow-up and adverse events (AEs) were recorded upon occurrence. RESULTS Of the 440 patients who underwent implant procedures, placement of the Attain Stability Quad lead was successful in 426 (96.8%). LV lead-related complications occurred in 10 patients (2.3%), including LV lead dislodgement in three patients (0.7%). The percentage of patients with at least one LV pacing vector with a PCT ≤2.5 V at a 6-month follow-up was 96.3%. The LV lead was successfully fixated to the prespecified pacing location in 97.4% of cases. CONCLUSIONS This large, multinational study of the Attain Stability Quad lead demonstrated a high rate of implant success with a low complication rate. The active fixation mechanism allowed precise placement of the pacing electrodes at the desired target region with good PCTs and a very low dislodgement rate.
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Affiliation(s)
- Kevin P Jackson
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina
| | - Svein Faerestrand
- Department of Clinical Science, University of Bergen and Haukeland University Hospital, Bergen, Norway
| | - Francois Philippon
- Department of Medicine, Institut Universitaire De Cardiologie Et De Pneumologie De Quebec, Quebec, Canada
| | - Raymond Yee
- Division of Cardiology, University Hospital, London, Ontario, Canada
| | | | - Axel Kloppe
- Medizinische Klinik II, BG Universitätsklinikum Bergmannsheil, Bochum, Germany
| | | | - Scott F Lee
- Baptist Heart Specialists, Ponte Vedra Beach, Florida
| | | | | | | | - George H Crossley
- Division of Cardiology, Vanderbilt University Heart and Vascular Institute, Nashville, Tennessee
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8
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Chapman M, Bates MGD, Behar JM, Williams I, Dewhurst M, Monkhouse C, Hayward C, Muthumala A, Chow A, Linker NJ, Thornley AR, Turley AJ. A Novel Quadripolar Active Fixation Left-Ventricular Pacing Lead for Cardiac Resynchronization Therapy: Initial United Kingdom Experience. JACC Clin Electrophysiol 2019; 5:1028-1035. [PMID: 31537331 DOI: 10.1016/j.jacep.2019.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/02/2019] [Accepted: 05/02/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study sought to assess immediate and short-term performance of the Medtronic Attain Stability Quadripolar 4798 lead (Medtronic, Dublin, Ireland). BACKGROUND Cardiac resynchronization therapy (CRT) is an established treatment for appropriately selected patients with left ventricular (LV) systolic dysfunction. The most common reason for failure to implant a lead is the lack of a suitable epicardial vein, due either to an absent vessel in the target site, an unacceptably high threshold, lead instability, phrenic nerve stimulation, or a combination of reasons. In August 2017, a novel quadripolar active fixation LV lead (Medtronic) was released. This paper reports the initial clinical experience with lead implantation and specifically immediate and short-term pacing parameters across 3 United Kingdom centers. METHODS Consecutive patients eligible for CRT were deemed suitable for this lead. Immediate and short-term lead performance data regarding LV threshold, impedance, and displacement rates were collected at standard pacing checks (1 day, 5 weeks, 3 months, and 9 months post-implantation). RESULTS CRT using this lead was attempted in 82 cases and was successful in 81 cases (98.8%). LV thresholds and impedance levels were 1.22 ± 0.75 V and 737 ± 319 Ω at implantation; 1.16 ± 0.71 V and 597 ± 218 Ω at day 1; 1.02 ± 0.48 V and 579 ± 148 Ω at week 6; 0.98 ± 0.49 V and 569 ± 133 Ω at 3 months; and 1.06 ± 0.48 V and 570 ± 140 Ω at 9 months. As of the publication of this paper, no LV lead has been displaced. CONCLUSIONS CRT using the Medtronic lead was successful in more than 98% of the patients. Short-to-medium-term data regarding lead performance and stability were excellent, with zero displacements as of the publication of this paper.
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Affiliation(s)
- Michael Chapman
- James Cook University Hospital, Middlesbrough, United Kingdom.
| | | | | | - Ian Williams
- Norfolk and Norwich University Hospital, United Kingdom
| | | | | | | | | | | | | | | | - Andrew J Turley
- James Cook University Hospital, Middlesbrough, United Kingdom
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9
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Ziacchi M, Palmisano P, Biffi M, Guerra F, Stabile G, Forleo GB, Zanotto G, D'Onofrio A, Landolina M, De Ponti R, Zoni Berisso M, Ricci RP, Boriani G. Lead choice in cardiac implantable electronic devices: an Italian survey promoted by AIAC (Italian Association of Arrhythmias and Cardiac Pacing). Expert Rev Med Devices 2019; 16:821-828. [PMID: 31348864 DOI: 10.1080/17434440.2019.1649134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Few data are available regarding lead preferences of electrophysiologists during cardiac implantable electronic devices (CIEDs) implantation. Aim of this survey is to evaluate the leads used, and the reasons behind these choices, in a large population of implanters. Methods: A questionnaire was sent to all 314 Italian centers with experience in CIED implantation. Results: 103 operators from 100 centers (32% of centers) responded. For atrium, passive leads represented first choice for pacemakers and defibrillators (71% and 64% of physicians, respectively), mainly for safety. For right ventricle, active fixation was preferred (61% and 93% operators in pacemaker and defibrillator patients), for higher versatility in positioning and lower dislodgement risk. For left ventricular stimulation, quadripolar leads were preferred by more than 80% of respondents, for better phrenic nerve and myocardial threshold management; active-fixation leads represent a second choice, in order to prevent or manage dislodgement (78% and 17% of respondents, respectively), but 44% of operators considered them dangerous. Conclusions: The choice of leads is heterogeneous. Trends are toward active-fixation right ventricular leads and passive-fixation atrial leads (particularly in pacemaker patients, considered frailer). For left ventricular stimulation, operators' majority want to disposition all kind of leads, although quadripolar leads are the favorites.
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Affiliation(s)
- Matteo Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital , Bologna , Italy
| | | | - Mauro Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi University Hospital , Bologna , Italy
| | - Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University , Ancona , Italy
| | | | | | | | | | | | - Roberto De Ponti
- Department of Heart and Vessels, Circolo Hospital, University of Insubria , Varese , Italy
| | | | | | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia , Modena , Italy
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10
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Ziacchi M, Giannola G, Lunati M, Infusino T, Luzzi G, Rordorf R, Pecora D, Bongiorni MG, De Ruvo E, Biffi M. Bipolar active fixation left ventricular lead or quadripolar passive fixation lead? An Italian multicenter experience. J Cardiovasc Med (Hagerstown) 2019; 20:192-200. [PMID: 30762662 DOI: 10.2459/jcm.0000000000000778] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS About one-third of patients receiving cardiac resynchronization therapy (CRT) are not responders, due to either patient selection or technical issues. Left ventricular quadripolar passive fixation leads (QPL) and bipolar active fixation (BAF) leads have been designed to ensure a targeted left ventricular stimulation area, minimizing lead dislodgments and phrenic nerve stimulation (PNS). The aim was to compare real-world safety and efficacy of BAF (Attain Stability, Medtronic Plc.) and QPL (Attain Performa, Medtronic Plc.). METHODS We performed a retrospective analysis examining procedural and follow-up data of 261 BAF and 124 QPL (programmed to single-site left ventricular pacing), included in the ClinicalService project from 16 Italian hospitals. RESULTS At median follow-up of 12 months, no difference in left ventricular pacing threshold was recorded between BAF and QPL (1.3 ± 0.9 V @0.4 ms vs. 1.3 ± 1.0 V @0.4 ms; P = 0.749). Total left ventricular lead dislodgement rate was 1.43/100 patient-years in BAF vs. 2.9/100 patient-years in QPL (P = 0.583). However, no dislodgements occurred among BAF after hospital discharge. Events requiring repeated surgery or permanently turning CRT off occurred in 0.8% of BAF, as compared with 4.0% of QPL (P = 0.025). There was no difference between groups in the echo CRT responders' rate (70% of BAF and 66% of QPL; P = 0.589) or in the annual rate of heart failure hospitalization (P = 0.513). CONCLUSIONS BAF resulted in noninferior clinical outcome and CRT responders' rate in comparison to QPL. Moreover, BAF ensured more precise and stable placement in cardiac veins, with comparable electrical performance and less than 1% patients with unsolved PNS.
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Affiliation(s)
- Matteo Ziacchi
- Azienda Ospedaliera Universitaria S. Orsola-Malpighi, Bologna
| | | | | | | | - Giovanni Luzzi
- Azienda Ospedaliero-Universitaria Policlinico Bari, Bari
| | - Roberto Rordorf
- Arrhythmias Unit, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia
| | | | | | | | - Mauro Biffi
- Azienda Ospedaliera Universitaria S. Orsola-Malpighi, Bologna
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11
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Ziacchi M, Diemberger I, Corzani A, Martignani C, Mazzotti A, Massaro G, Valzania C, Rapezzi C, Boriani G, Biffi M. Cardiac resynchronization therapy: a comparison among left ventricular bipolar, quadripolar and active fixation leads. Sci Rep 2018; 8:13262. [PMID: 30185834 PMCID: PMC6125407 DOI: 10.1038/s41598-018-31692-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/08/2018] [Indexed: 11/09/2022] Open
Abstract
We evaluated the performance of 3 different left ventricular leads (LV) for resynchronization therapy: bipolar (BL), quadripolar (QL) and active fixation leads (AFL). We enrolled 290 consecutive CRTD candidates implanted with BL (n = 136) or QL (n = 97) or AFL (n = 57). Over a minimum 10 months follow-up, we assessed: (a) composite technical endpoint (TE) (phrenic nerve stimulation at 8 V@0.4 ms, safety margin between myocardial and phrenic threshold <2V, LV dislodgement and failure to achieve the target pacing site), (b) composite clinical endpoint (CE) (death, hospitalization for heart failure, heart transplantation, lead extraction for infection), (c) reverse remodeling (RR) (reduction of end systolic volume >15%). Baseline characteristics of the 3 groups were similar. At follow-up the incidence of TE was 36.3%, 14.3% and 19.9% in BL, AFL and QL, respectively (p < 0.01). Moreover, the incidence of RR was 56%, 64% and 68% in BL, AFL and QL respectively (p = 0.02). There were no significant differences in CE (p = 0.380). On a multivariable analysis, "non-BL leads" was the single predictor of an improved clinical outcome. QL and AFL are superior to conventional BL by enhancing pacing of the target site: AFL through prevention of lead dislodgement while QL through improved management of phrenic nerve stimulation.
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Affiliation(s)
- M Ziacchi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy.
| | - I Diemberger
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Corzani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Martignani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - A Mazzotti
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - G Massaro
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Valzania
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - C Rapezzi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - G Boriani
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
- Cardiology Division. Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - M Biffi
- Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Policlinico S.Orsola-Malpighi, Bologna, Italy
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12
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Dell'Era G, Porcellini S, Boggio E, Prenna E, Gravellone M, Varalda M, Erbetta R, Lio V, Occhetta E, Marino P. Transcatheter leadless pacemaker implantation in a patient with failing transvenous pacemaker and total occlusion of superior vena cava. J Cardiovasc Med (Hagerstown) 2018; 19:511-512. [PMID: 29985798 DOI: 10.2459/jcm.0000000000000689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Gabriele Dell'Era
- Division of Clinical Cardiology, Azienda Ospedaliera Universitaria 'Maggiore della Carità,' Novara, Italy
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13
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Lau EW. Multi-site multi-polar left ventricular pacing through persistent left superior vena cava in tricuspid valve disease. Indian Pacing Electrophysiol J 2017; 17:156-159. [PMID: 29192594 PMCID: PMC5652279 DOI: 10.1016/j.ipej.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 05/25/2017] [Accepted: 05/29/2017] [Indexed: 11/26/2022] Open
Abstract
Multi-site multi-polar left ventricular pacing through the coronary sinus (CS) may be preferred over endocardial right ventricular or surgical epicardial pacing in the presence of tricuspid valve disease. However, the required lead placement can be difficult through a persistent left superior vena cava (PLSVC), as the CS tends to be hugely dilated and side branches tend to have sharp angulations (>90°) when approached from the PLSVC. Pre-shaped angiography catheters and techniques used for finding venous grafts from the ascending aorta post coronary bypass surgery may help with lead placement in such a situation.
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Affiliation(s)
- Ernest W Lau
- Department of Cardiology, Royal Victoria Hospital, Grosvenor Road, Belfast BT12 6BA, Northern Ireland, UK.
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14
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Kranig W, Amberger J, Awad K, Wolff E, Vahlkamp K, Thale J, Küpper B. Implantation meets intervention: reopening of a thrombotic ostial occlusion of coronary sinus by angioplasty achieved improvement of cardiac venous drainage and allowed transvenous CRT implantation. Clin Res Cardiol 2017; 106:1033-1039. [PMID: 28921055 DOI: 10.1007/s00392-017-1141-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Accepted: 07/25/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Wolfgang Kranig
- Department of Cardiology, Electrophysiology Division, Schüchtermann Clinic, Heart Centre Osnabrück-Bad Rothenfelde, Bad Rothenfelde, Germany.
| | - Johannes Amberger
- Department of Cardiology, Electrophysiology Division, Schüchtermann Clinic, Heart Centre Osnabrück-Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Khaled Awad
- Department of Cardiology, Electrophysiology Division, Schüchtermann Clinic, Heart Centre Osnabrück-Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Enrik Wolff
- Department of Cardiology, Electrophysiology Division, Schüchtermann Clinic, Heart Centre Osnabrück-Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Kerstin Vahlkamp
- Department of Cardiology, Electrophysiology Division, Schüchtermann Clinic, Heart Centre Osnabrück-Bad Rothenfelde, Bad Rothenfelde, Germany
| | - Joachim Thale
- Department of Cardiology, Electrophysiology Division, Schüchtermann Clinic, Heart Centre Osnabrück-Bad Rothenfelde, Bad Rothenfelde, Germany
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15
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Cronin EM. Coronary Venous Lead Extraction. J Innov Card Rhythm Manag 2017; 8:2758-2764. [PMID: 32494456 PMCID: PMC7252920 DOI: 10.19102/icrm.2017.080604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 04/18/2017] [Indexed: 11/06/2022] Open
Abstract
The increasing number of cardiac resynchronization therapy devices implanted, coupled with the increasing incidence of cardiac implantable electronic device infection, has led to a greater need for extraction of coronary venous pacing leads. The objectives of this study were to review the indications, techniques and published results of coronary venous lead extraction. In this study, we searched PubMed using the search terms "lead extraction," "coronary sinus," "coronary venous," "pacing," and "cardiac resynchronization therapy" for relevant papers. The reference lists of relevant articles were also searched, and personal experience was drawn upon. Published success rates and complications were found to be similar to those reported for non-coronary venous leads in experienced centers. However, reimplantation success differs and can be limited by vessel occlusion postextraction. The available active fixation coronary sinus lead (Attain Starfix™; Medtronic, MN, USA) is a particularly complex lead to extract, whereas limited data on the newer active fixation leads (Attain Stability™, Medtronic, MN, USA) suggest that they are less challenging to remove. The study concluded that coronary venous lead extraction presents unique challenges, especially reimplantation, that require special consideration and planning to overcome.
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Affiliation(s)
- Edmond M Cronin
- Hartford HealthCare Heart and Vascular Institute at Hartford Hospital, Hartford, CT.,University of Connecticut School of Medicine, Farmington, CT
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