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Orlov MV, Casavant D, Koulouridis I, Maslov M, Erez A, Hicks A, Jahangir A, Aoun J, Wylie JV. Permanent His-bundle pacing using stylet-directed, active-fixation leads placed via coronary sinus sheaths compared to conventional lumen-less system. Heart Rhythm 2019; 16:1825-1831. [PMID: 31425775 DOI: 10.1016/j.hrthm.2019.08.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND The use of coronary sinus (CS) sheaths to deliver stylet-driven leads (SDLs) for His-bundle pacing (HBP) has not been described. Conventionally, HBP is achieved using a stylet-less lead delivered through a customized catheter. OBJECTIVE The purpose of this study was to characterize the acute and early-term HBP experience with stylet-driven, active-fixation leads delivered through CS sheaths compared to the conventional approach. METHODS Delivery of Medtronic 4471 and 7742 SDLs was attempted in 27 patients. Delivery was facilitated using CS guide catheters and custom-shaped stylets. Procedural characteristics and lead performance were compared to those of a group of 17 patients in whom delivery of 3830 lumen-less leads (LLLs) was attempted. Patients had heterogeneous pacing indications. RESULTS HBP with SDL was successful in 24 of 27 patients(89%) compared to 15 of 17 patients (88%) in the LLL group. Mean procedural and fluoroscopy times in the SDL and LLL groups were 129 ± 43 minutes vs 104 ± 43 minutes and 9.6 ± 5.2 minutes vs 8.3 ± 5.0 minutes, respectively (both P = NS). There was a significant difference in procedure and fluoroscopy times within the SDL group between the first and second halves of the series, probably secondary to a learning curve. Acute HBP thresholds were higher with SDL than with LLL (2.6 ± 1.5 V vs 1.5 ± 1.2 V; P = .02) and remained stable at 8.4 ± 5.3 months. Both SDLs exhibited similar pacing thresholds. Two crossovers between groups occurred (1 in each group). Four patients with SDL and 1 patient with LLL exhibited high thresholds during follow-up. CONCLUSION Permanent HBP using stylet-driven, active-fixation leads delivered through conventional CS sheaths is feasible. Procedural characteristics and lead performance were clinically acceptable.
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Affiliation(s)
- Michael V Orlov
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center, Boston, Massachusetts; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts.
| | | | - Ioannis Koulouridis
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center, Boston, Massachusetts; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Mikhail Maslov
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center, Boston, Massachusetts; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Aharon Erez
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center, Boston, Massachusetts; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Amy Hicks
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center, Boston, Massachusetts
| | - Ahad Jahangir
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center, Boston, Massachusetts
| | - Joe Aoun
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center, Boston, Massachusetts; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - John V Wylie
- Department of Medicine, Division of Cardiology, Section of Electrophysiology, Steward St. Elizabeth's Medical Center, Boston, Massachusetts; Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
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Sato A, Chinushi M, Izumi D, Furushima H, Minamino T. Malfunction of cardiac resynchronization therapy due to subsequent fracture of the ring and tip conductors of a co-radial left ventricular bipolar lead. Intern Med 2013; 52:1189-93. [PMID: 23728553 DOI: 10.2169/internalmedicine.52.8988] [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] [Indexed: 11/06/2022] Open
Abstract
In two patients treated with cardiac resynchronization therapy (CRT), left ventricular (LV) pacing failure occurred due to ring conductor fractures of the bipolar LV lead (co-radial model). CRT was resumed by pacing between the tip conductor of the LV lead and the coil conductor of the right ventricular lead. However, shortly thereafter, subsequent fracture of the tip conductor developed, and implantation of a new LV lead was required. When one of the bipolar conductors of a co-radial designed LV lead fractures, reimplantation of a new LV lead is a better therapeutic option (than changing the LV pacing mode) in order to reliably continue CRT treatment.
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Affiliation(s)
- Akinori Sato
- Department of Cardiovascular Biology and Medicine, Niigata University Graduate School of Medical, Dental Sciences, Japan
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