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Chen M, Wang Z, Wang S, Zhu T, Liu Z, Li X, Wu Z, Liu Q, Zhou S. Bedside temporary transvenous cardiac pacing lead placement in patients with tricuspid valve surgery without guidance of X‐ray: A single‐center experience. Ann Noninvasive Electrocardiol 2022; 27:e13006. [DOI: 10.1111/anec.13006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/15/2022] [Accepted: 08/10/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mingxian Chen
- Department of Cardiology The Second Xiangya Hospital of Central South University Changsha China
| | - Zhuo Wang
- Department of Cardiology Wuhan Renmin Hospital of Wuhan University Wuhan China
| | - Songyun Wang
- Department of Cardiology Wuhan Renmin Hospital of Wuhan University Wuhan China
| | - Tongjian Zhu
- Department of Cardiology Wuhan Renmin Hospital of Wuhan University Wuhan China
| | - Zhenjiang Liu
- Department of Cardiology The Second Xiangya Hospital of Central South University Changsha China
| | - Xuping Li
- Department of Cardiology The Second Xiangya Hospital of Central South University Changsha China
| | - Zhihong Wu
- Department of Cardiology The Second Xiangya Hospital of Central South University Changsha China
| | - Qiming Liu
- Department of Cardiology The Second Xiangya Hospital of Central South University Changsha China
| | - Shenghua Zhou
- Department of Cardiology The Second Xiangya Hospital of Central South University Changsha China
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Zha K, Cui K, Liu X, Fang Y. Clinical investigation of left ventricular pacing using coronary sinus in patients with mechanical prosthetic tricuspid valve replacement. Clin Cardiol 2017; 40:1139-1144. [PMID: 29166536 DOI: 10.1002/clc.22800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 08/10/2017] [Accepted: 08/16/2017] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although transvenous right ventricular (RV) endocardial lead placement is routine practice in clinical pacing, RV inaccessibility in certain clinical situations mandates the search for other sites. HYPOTHESIS This study is aimed to verify whether left ventricular lead through coronary sinus is safe and efficient. METHODS Based on a retrospective analysis of a single-center series of 4 patients with inaccessibility for RV pacing, we report on the feasibility and reliability of coronary sinus (CS) pacing via left ventricular (LV) lead, which usually is used in cardiac resynchronization therapy. Four patients with valvular heart disease and bradycardias post-mechanical prosthetic tricuspid valve replacement were studied. The LV leads were implanted into the lateral vein or great cardiac vein of the CS, and all parameters were programmed postprocedure. RESULTS In all cases procedures yielded favorable parameters, with 1 CS dissection. At long-term follow-up, there was no threshold increase or lead dislocation. CONCLUSIONS LV lead implantation through the CS appears safe and efficacious in patients with inaccessibility for RV pacing.
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Affiliation(s)
- Kelan Zha
- Department of Cardiology, West China School of Medicine, Sichuan University, Chengdu, China.,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Xingbin Liu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yuan Fang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Abstract
Most cardiovascular implantable electronic devices (CIEDs) require a ventricular lead to be placed across the tricuspid valve. Tricuspid regurgitation (TR) is an understudied clinical complication of right ventricular lead implantation and its clinical significance is unknown. We review the incidence, predictors, and current management of TR as a complication of ventricular lead implantation. Emerging technologies, including leadless pacing devices and subcutaneous systems, offer the benefit of little or none tricuspid valve disruption.
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Jo KH, Kim I, Ann SH, Oh YS. Implantation of a permanent pacemaker through the coronary sinus in a patient who underwent mechanical valve replacement for infective endocarditis with a complete atrioventricular block. Yeungnam Univ J Med 2014. [DOI: 10.12701/yujm.2014.31.2.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Kwan Hoon Jo
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Inho Kim
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Soe Hee Ann
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Yong Seog Oh
- Division of Cardiology, Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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Conti S, Liotta C, Virgilio A, Tamburino C, Calvi V. Left Ventricular Pacing in a Patient with a Mechanical Tricuspid Prosthesis and High Surgical Risk. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/wjcd.2014.412068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vijayakumar M, Kamath P, Pai PG. Permanent pacing in a patient with tricuspid prosthesis--widening therapeutic use of coronary sinus. Indian Heart J 2013; 65:611-3. [PMID: 24206887 DOI: 10.1016/j.ihj.2013.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 08/10/2013] [Indexed: 11/26/2022] Open
Abstract
Unconventional sites are being used for pacing in patients with inaccessible right ventricle like single ventricle, atresia of tricuspid valve and in anomalous venous drainage. Here we report a case in which the right ventricle could not be accessed due to the metallic prosthesis. A 41-year-old lady required triple valve replacement for rheumatic involvement. Permanent pacemaker implantation was done with epicardial lead for bradycardia post operatively. Pulse generator change was needed within 3 years as the pacemaker reached end of life due to high lead threshold. Subsequent pacemaker implantation was done with a left ventricular lead in coronary sinus by percutaneous approach. One year after implantation, the threshold remains stable. Coronary sinus can be utilized for permanent pacing in patients with inaccessible right ventricle due to prosthetic tricuspid valve.
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Affiliation(s)
- Maniyal Vijayakumar
- Clinical Professor, Amrita Institute of Medical Sciences and Research Center, Kochi, India.
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8
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Lopez JA. Implantable cardioverter defibrillator lead placement in the middle cardiac vein after tricuspid valve surgery. Europace 2012; 14:853-8. [DOI: 10.1093/europace/eus013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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9
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Swampillai J, Heald SC, Devlin GP, Stiles MK. Ventricular Pacing via the Coronary Sinus in a Patient with a Mechanical Tricuspid Valve Prosthesis. J Arrhythm 2011. [DOI: 10.1016/s1880-4276(11)80037-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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10
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Grimard C, Clémenty N, Fauchier L, Babuty D. Ventricular Pacing Through Coronary Sinus in Patients With Tricuspid Prosthesis. Ann Thorac Surg 2010; 89:e51-2. [DOI: 10.1016/j.athoracsur.2010.03.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/21/2010] [Accepted: 03/11/2010] [Indexed: 10/19/2022]
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LOPEZ JALBERTO, LUFSCHANOWSKI ROBERTO. A Novel Approach to Transvenous Dual-Chamber Pacing Lead Placement and Cardiac Defibrillator Implantation After Tricuspid Valve Replacement. J Cardiovasc Electrophysiol 2008; 19:873-5. [DOI: 10.1111/j.1540-8167.2007.01059.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Estner HL, Kolb C, Schmitt C, Deisenhofer I, Pflaumer A, Eicken A, Zrenner B, Hessling G. Long-term transvenous AV-sequential pacing in a failing atriopulmonary Fontan patient. Int J Cardiol 2008; 127:e93-5. [PMID: 17764764 DOI: 10.1016/j.ijcard.2007.04.085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2007] [Accepted: 04/12/2007] [Indexed: 10/22/2022]
Abstract
UNLABELLED We report on a 32-year-old man with tricuspid atresia, pulmonary stenosis and hypoplastic right ventricle. He had received a Fontan-Kreutzer procedure (anastomosis between the right atrial appendage and the pulmonary artery) at the age of 14 years. At the age of 2 years, an abdominal VVI-pacemaker with an epicardial ventricular lead had been implanted because of symptomatic third degree AV-block. The patient was now hospitalized with symptoms of severe congestive heart failure. A least invasive approach restoration of AV-synchrony by a dual chamber pacer was performed. Therefore a complete transvenous approach to avoid thoracotomy was attempted. A specially designed CS lead was advanced via the CS to a left lateral ventricular vein for ventricular stimulation. After institution of dual chamber pacing the patient recovered of his heart failure. During a follow-up time of 20 months the patient was clinically stable in the AV-sequential pacing. CONCLUSION Dual chamber pacing using a transvenously placed coronary sinus lead for ventricular stimulation may improve congestive heart failure in patients after the classic Fontan operation. The minimally invasive transvenous approach might be the best solution for patients who need a pacemaker and are not candidates for surgery or heart transplantation.
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Yoda M, Nakai T, Okubo K, Hata M, Sezai A, Hirayama A, Minami K. First Case Report in Japan of Left Ventricular Pacing via a Coronary Vein in a Patient With a Mechanical Tricuspid Valve. Circ J 2008; 72:335-6. [DOI: 10.1253/circj.72.335] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Masataka Yoda
- Department of Thoracic and Cardiovascular Surgery, Nihon University School of Medicine
| | - Toshiko Nakai
- Department of Cardiology, Nihon University School of Medicine
| | - Kimie Okubo
- Department of Cardiology, Nihon University School of Medicine
| | - Mitsumasa Hata
- Department of Thoracic and Cardiovascular Surgery, Nihon University School of Medicine
| | - Akira Sezai
- Department of Thoracic and Cardiovascular Surgery, Nihon University School of Medicine
| | | | - Kazutomo Minami
- Department of Thoracic and Cardiovascular Surgery, Nihon University School of Medicine
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GIUDICI MICHAELC, TIGRETT DARRYNW, CARLSON JACQUELINEI, LORENZ TERRID, PAUL DEBORAHL, BAROLD SSERGE. Electrocardiographic Patterns during:. Pacing the Great Cardiac and Middle Cardiac Veins. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2007; 30:1376-80. [DOI: 10.1111/j.1540-8159.2007.00874.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lopez JA, Lufschanowski R. Transvenous bifocal left ventricular pacing after mechanical prosthetic tricuspid valve replacement with use of echocardiography to optimize pacing parameters. J Interv Card Electrophysiol 2007; 18:233-7. [PMID: 17516159 DOI: 10.1007/s10840-007-9097-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2006] [Accepted: 03/06/2007] [Indexed: 10/23/2022]
Abstract
A 56-year-old woman underwent placement of a permanent pacemaker to treat symptomatic bradycardia; she had a documented, severe atrioventricular (AV) conduction abnormality and was not taking any AV node-blocking drugs. She had a mechanical prosthetic valve in the tricuspid position, which had been implanted for severe valvular insufficiency caused by rheumatic heart disease. Pacing leads were successfully placed transvenously in the anterior cardiac and a posterolateral vein, which avoided the need for repeat thoracotomy. Echocardiographic and Doppler parameters were used to optimize interventricular as well as septal-to-lateral left ventricular (LV) time delay and reduce or avoid interventricular and LV mechanical dyssynchrony.
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Affiliation(s)
- J Alberto Lopez
- Texas Heart Institute at St. Luke's Episcopal Hospital and Baylor College of Medicine, Houston, TX 77030, USA.
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16
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Biffi M, Bertini M, Ziacchi M, Boriani G. Transvenous Cardioverter-Defibrillator Implantation in a Patient with Tricuspid Mechanical Prosthesis. J Cardiovasc Electrophysiol 2007; 18:329-31. [PMID: 17319002 DOI: 10.1111/j.1540-8167.2006.00686.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND A 64-year-old woman was referred to our center because of poorly tolerated ventricular tachycardia (VT) at 210 bpm due to an old myocardial infarction. The patient had been operated on at age of 20 for mitral valve commissurolysis, at age of 49 for ductal carcinoma, at age of 56 for mitral valve replacement, and at age of 61 for tricuspid valve replacement. Left ventricular EF was 31%. The patient was in permanent atrial fibrillation (AF) since the age of 53. She had undergone three cardiac surgery procedures, ending with two prosthetic mechanical valves. The cardiac surgery team advised against an epicardial ICD implantation. RESULTS We achieved a fully transvenous implant, with a screw-in defibrillation coil in the low right atrium and a bipolar pacing/sensing lead in a posterolateral branch of the coronary sinus. Pacing/sensing parameters were reliable, and effective defibrillation occurred at 20 J by a stepdown protocol. During 16-month follow-up, three VT episodes at 210 bpm were terminated by antitachycardia pacing (ATP) therapy. Left ventricular pacing/sensing was stable at long term. CONCLUSION Thanks to technologic improvements, transvenous ICD implantation is feasible and safe in patients with a tricuspid mechanical prosthesis.
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Affiliation(s)
- Mauro Biffi
- Institute of Cardiology, University of Bologna, Via Massarenti 9, 40138 Bologna, Italy.
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Lopez JA, Leachman DR. Successful Use of Transvenous Atrial and Bifocal Left Ventricular Pacing in Ebstein’s Anomaly After Tricuspid Prosthetic Valve Surgery. Ann Thorac Surg 2007; 83:1183-5. [PMID: 17307491 DOI: 10.1016/j.athoracsur.2006.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2006] [Revised: 07/19/2006] [Accepted: 08/03/2006] [Indexed: 11/23/2022]
Abstract
A 62-year-old woman with Ebstein's anomaly and a tricuspid valve prosthesis underwent placement of a permanent atrioventricular pacemaker to treat highly symptomatic sinus node dysfunction and atrioventricular block. Transvenous bipolar leads were placed in the anterior cardiac and lateral coronary veins and were set to optimal ventricular pacing parameters to preserve prosthetic valve function, back-up ventricular pacing, and maintain atrioventricular and interventricular synchrony. An atrial septal lead was placed to control atrial pacing. Interventricular and atrioventricular timing were optimized with the use of tissue Doppler imaging and the Doppler-derived stroke volume.
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Affiliation(s)
- J Alberto Lopez
- Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA.
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18
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Hsieh MJ, Yeh KH, Satish OS, Wang CC. Permanent pacing using a coronary sinus lead in a patient with univentricular physiology: an extended application of biventricular pacing technology. ACTA ACUST UNITED AC 2006; 8:147-50. [PMID: 16627429 DOI: 10.1093/europace/euj023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In the past, patients requiring permanent pacing with difficult right ventricular (RV) access were usually subjected to epicardial pacing by a surgical approach. This report describes a young patient with univentricular physiology following repeated palliative surgery for complex congenital heart disease. The patient had symptomatic complete heart block and a dual chamber pacemaker with transvenous atrial and ventricular leads was implanted successfully. The ventricle was paced through the posterolateral cardiac vein with a lead specially designed for cardiac resynchronization therapy. This case illustrates an extended application of the recently developed coronary sinus lead in selected patients, when conventional RV endocardial pacing is impossible.
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Affiliation(s)
- Ming-Jer Hsieh
- Second Section of Cardiology, Department of Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
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19
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Yoda M, Hansky B, Schulte-Eistrup S, Koerfer R, Minami K. Left ventricular pacing through the anterior interventricular vein in a patient with mechanical tricuspid, aortic and mitral valves. Ann Thorac Surg 2005; 80:328-30. [PMID: 15975398 DOI: 10.1016/j.athoracsur.2004.01.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2003] [Revised: 12/29/2003] [Accepted: 01/09/2004] [Indexed: 11/19/2022]
Abstract
Transvenous endocardial pacemaker implantation is contraindicated in patients after mechanical tricuspid valve replacement. A 76-year-old woman who suffered from bradyarrhythmia was implanted with a left ventricular pacing lead through a transvenous coronary vein after aortic, mitral, and tricuspid valve replacements. There were no complications and the stimulation thresholds were stable. The use of coronary vein leads provides a minimally invasive approach, safety, and effective stimulation for patients with a mechanical tricuspid valve.
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Affiliation(s)
- Masataka Yoda
- Department of Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, University of Bochum, Bad Oeynhausen, Germany.
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20
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Kistler PM, Mond HG, Corcoran SJM. Biventricular pacing: it isn't always as it seems. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2004; 26:2185-7. [PMID: 14622326 DOI: 10.1046/j.1460-9592.2003.00342.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cardiac desynchronization therapy has established benefits in the management of symptomatic heart failure patients, although left ventricular lead placement remains challenging. We present a case report involving apparent biventricular pacing via the great cardiac vein, which through an appreciation of the surface ECG, revealed dual site right ventricular pacing.
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Affiliation(s)
- Peter M Kistler
- Department of Cardiology, The Royal Melbourne Hospital, Victoria, Australia
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21
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Gerber TC, Nishimura RA, Holmes DR, Lloyd MA, Zehr KJ, Tajik AJ, Hayes DL. Left ventricular and biventricular pacing in congestive heart failure. Mayo Clin Proc 2001; 76:803-12. [PMID: 11499820 DOI: 10.1016/s0025-6196(11)63225-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dual-chamber pacing improved hemodynamics acutely in a subset of patients with left ventricular (LV) dysfunction but conveyed no long-term symptomatic benefit in most. More recently, LV pacing and biventricular (multisite) pacing have been used to improve systolic contractility by altering the electrical and mechanical ventricular activation sequence in patients with severe congestive heart failure (CHF) and intraventricular conduction delay or left bundle branch block (LBBB). Intraventricular conduction delay and LBBB cause dyssynchronous right ventricular and LV contraction and worsen LV dysfunction in cardiomyopathies. Both LV and biventricular cardiac pacing are thought to improve cardiac function in this situation by effecting a more coordinated and efficient ventricular contraction. Short-term hemodynamic studies have shown improvement in LV systolic function, which seems more pronounced with monoventricular LV pacing than with biventricular pacing. Recent clinical studies in limited numbers of patients suggest long-term clinical benefit of biventricular pacing in patients with severe CHF symptoms. Continuing and future studies will demonstrate whether and in which patients LV and biventricular pacing are permanently effective and equivalent and which pacing site within the LV produces the most beneficial hemodynamic results.
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MESH Headings
- Bundle-Branch Block/complications
- Bundle-Branch Block/physiopathology
- Bundle-Branch Block/therapy
- Cardiac Pacing, Artificial/methods
- Cardiomyopathy, Dilated/complications
- Cardiomyopathy, Dilated/physiopathology
- Cardiomyopathy, Dilated/therapy
- Heart Failure/etiology
- Heart Failure/physiopathology
- Heart Failure/therapy
- Heart Ventricles/physiopathology
- Hemodynamics
- Humans
- Pacemaker, Artificial
- Time Factors
- Treatment Outcome
- Ventricular Dysfunction, Left/complications
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/therapy
- Ventricular Dysfunction, Right/complications
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Dysfunction, Right/therapy
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Affiliation(s)
- T C Gerber
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minn 55905, USA
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Batur MK, Akgül E, Ovünç K. Permanent left ventricular pacing from the great cardiac vein of a patient with artificial tricuspid and mitral valves--a case report. Angiology 2000; 51:1027-30. [PMID: 11132995 DOI: 10.1177/000331970005101208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Transvenous placement of a right ventricular pacemaker lead through the artificial tricuspid valve is a known contraindication, and in this situation, epicardial pacemaker implantation is the procedure of choice. However, permanent pacemaker implantation is a subject for debate when the use of the epicardial route is impossible. This report describes alternate transvenous routes for a pacemaker lead in a patient with an artificial tricuspid valve and mitral valve in whom the epicardial lead and pacemaker generator must be removed because of resistant infection.
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Affiliation(s)
- M K Batur
- Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkey.
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Blanc JJ, Benditt DG, Gilard M, Etienne Y, Mansourati J, Lurie KG. A method for permanent transvenous left ventricular pacing. Pacing Clin Electrophysiol 1998; 21:2021-4. [PMID: 9826852 DOI: 10.1111/j.1540-8159.1998.tb01119.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
LV-based pacing has recently been reported to be of benefit in patients with severe cardiac failure and left bundle branch block. LV permanent pacing has been reported using epicardial leads but the surgical mortality is excessive. A transvenous approach is now favored. In this regard, cannulation of the coronary sinus and of one of its tributaries using only the permanent electrode is feasible but technically challenging. We describe a "long guiding sheath" method using catheterization, and a long radiopaque and peelable sheath. Once the coronary sinus is cannulated with the electrophysiological catheter, the long sheath is advanced to the mid-part of the coronary sinus. The permanent pacing electrode is then placed through the sheath and into a tributary of the coronary sinus. This method has been attempted in 10 patients and was successful in 8, with an average lead insertion time of 21 +/- 5.5 minutes and an average fluoroscopic time of 11 +/- 5.5 minutes. In conclusion, although transvenous left ventricular pacing remains a challenge, the "long guiding sheath" approach appears to facilitate this procedure with both a high success rate and an acceptable procedure time.
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Affiliation(s)
- J J Blanc
- Department of Cardiology, Brest University-Hospital, France
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Daubert JC, Ritter P, Le Breton H, Gras D, Leclercq C, Lazarus A, Mugica J, Mabo P, Cazeau S. Permanent left ventricular pacing with transvenous leads inserted into the coronary veins. Pacing Clin Electrophysiol 1998; 21:239-45. [PMID: 9474680 DOI: 10.1111/j.1540-8159.1998.tb01096.x] [Citation(s) in RCA: 206] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This paper describes a preliminary experiment-conducted jointly by 2 centers-of permanent left ventricular pacing using leads inserted by the transvenous route and through the coronary sinus into the cardiac veins of the left ventricle free wall. The aim was to obtain permanent biventricular pacing in a totally endocavitary configuration in patients with severe LV dysfunction and drug-refractory heart failure. Two types of leads were used: nonspecific unipolar leads at the beginning of the experiment, followed by leads specifically designed to be used in the coronary sinus in a second step. The electrode could be fitted in an adequate location in 35 of the 47 patients (75.4%), with a 1.15 +/- 0.7 V acute pacing threshold and 11.8 +/- 5.7 mV R wave amplitude. The success rate was significantly higher with the specific electrodes (81.8% vs 53.3%, p < 0.001). The pacing and sensing thresholds upon implantation were not influenced by the type of lead or by the localization of the cardiac vein that was catheterized (great cardiac vein, lateral vein, postero-lateral or posterior vein, mid cardiac vein). In contrast, the pacing threshold was significantly lower (0.8 +/- 0.2 vs 1.8 +/- 0.8 V; p = 0.002) and the R wave amplitude tended to be greater (13.1 +/- 4.5 mV vs 9.3 +/- 6.5 mV; p = 0.07) when the tip electrode could be inserted distally into the vein, by comparison with a proximal site near the ostium. At the end of follow-up (10.2 +/- 8.7 months), 34 out of the 35 leads were still fully functional, with a chronic pacing threshold of 1.8 +/- 0.7 V and a R wave amplitude of 10.7 +/- 6 mV. To conclude, permanent LV pacing via the transvenous route is possible in most patients, with excellent safety and long-term results.
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Affiliation(s)
- J C Daubert
- Service de Cardiologie A, Hotel Dieu/CHRU 35033 Rennes, France
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