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Lead Position (lead + position)

Distribution by Scientific Domains
Medical Sciences100%

Kinds of Lead Position

  • lv lead position
    		•

    Selected Abstracts

    Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization Therapy

    CONGESTIVE HEART FAILURE, Issue 2 2009
    David Tepper MD
    Background., A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT. Methods., The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest x-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. Results., Significant LV reverse remodeling (reduction in LV end-systolic volume from 189±83 mL to 134±71 mL, P<.001) was noted in the group of patients with a concordant LV lead position (n=153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32±16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, P=.004). Conclusions., Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up. [source]

    Electrocardiogram-Based Algorithm to Predict the Left Ventricular Lead Position in Recipients of Cardiac Resynchronization Systems

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2009
    SYLVAIN PLOUX M.D.
    Introduction: Biventricular pacing is associated with various electrocardiographic patterns depending on the position of the left ventricular (LV) lead. We aimed to develop an electrocardiogram-based algorithm to predict the position of the LV lead. Methods: The algorithm was developed in 100 consecutive recipients of cardiac resynchronization therapy (CRT) systems. QRS axis, morphology, and polarity were analyzed with a view to define the specific electrocardiographic characteristics associated with the various LV lead positions. The algorithm was prospectively validated in 50 consecutive CRT device recipients. Results: The first analysis of the algorithm was the QRS morphology in V1. A positive R wave in V1 suggested LV lateral or posterior wall stimulation. A QS pattern was specific of anterior LV leads. In the presence of an R wave in V1, V6 was analyzed to distinguish between an inferior and anterior LV lead. Inferior leads were never associated with a positive V6. To differentiate between lateral and posterior positions, we analyzed the pattern in V2. Lateral leads were associated with an R morphology in V1 and a negative V2. Posterior leads were associated with an R morphology in V1 and V2. The algorithm allowed a reliable distinction between an inferior or anterior and a lateral or posterior lead position in 90% of patients. Inferior, anterior, lateral, and posterior positions were reliably distinguished in 80% of patients. Conclusion: This algorithm predicted the position of the LV lead with a high sensitivity and predictive value. [source]

    Optimal Left Ventricular Lead Position Predicts Reverse Remodeling and Survival After Cardiac Resynchronization Therapy

    CONGESTIVE HEART FAILURE, Issue 2 2009
    David Tepper MD
    Background., A nonoptimal LV pacing lead position may be a potential cause for nonresponse to CRT. Methods., The site of latest mechanical activation was determined by speckle tracking radial strain analysis and related to the LV lead position on chest x-ray in 244 CRT candidates. Echocardiographic evaluation was performed after 6 months. Long-term follow-up included all-cause mortality and hospitalizations for heart failure. Results., Significant LV reverse remodeling (reduction in LV end-systolic volume from 189±83 mL to 134±71 mL, P<.001) was noted in the group of patients with a concordant LV lead position (n=153, 63%), whereas patients with a discordant lead position showed no significant improvements. In addition, during long-term follow-up (32±16 months), less events (combined for heart failure hospitalizations and death) were reported in patients with a concordant LV lead position. Moreover, a concordant LV lead position appeared to be an independent predictor of hospitalization-free survival after long-term CRT (hazard ratio: 0.22, P=.004). Conclusions., Pacing at the site of latest mechanical activation, as determined by speckle tracking radial strain analysis, resulted in superior echocardiographic response after 6 months of CRT and better prognosis during long-term follow-up. [source]

    Effect of Left Ventricular Lead Concordance to the Delayed Contraction Segment on Echocardiographic and Clinical Outcomes after Cardiac Resynchronization Therapy

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2009
    JEFFREY W.H. FUNG M.D.
    Introduction: The optimal left ventricular (LV) pacing site for cardiac resynchronization therapy (CRT) is unclear. The current study aims to explore the clinical significance of LV lead concordance to delayed contraction segment in CRT. Methods and Results: Concordant LV lead position was defined as the lead tip located by fluoroscopy at or immediately adjacent to the LV segment with latest contraction determined by tissue Doppler imaging. Echocardiographic and clinical outcomes among 101 consecutive patients with or without concordant LV lead positions were compared. There was no significant difference in changes in LV volumes and clinical parameters between patients with concordant (n = 46) or nonconcordant (n = 55) LV lead positions at 3 and 6 months. In multivariate analysis, the baseline asynchrony index (,= 1.092, 95% CI: 1.050,1.114; P < 0.001), but not LV lead concordance, was the only independent predictor of LV reverse remodeling. By Cox regression analysis, ischemic etiology, and LV reverse remodeling, but not LV lead concordance, were independent predictors of mortality (,= 2.475, 95% CI: 1.183,5.178; P = 0.016, and ,= 0.272, 95% CI: 0.130,0.567; P < 0.001, respectively), cardiovascular hospitalization (,= 1.551, 95% CI: 1.032,2.333; P = 0.035, and ,= 0.460, 95% CI: 0.298,0.708; P < 0.001, respectively), and heart failure hospitalization (,= 0.486, 95% CI: 0.320,0.738; P = 0.001 for LV reverse remodeling). Conclusion: LV lead concordance to the delayed contraction segment may not be a major determining factor for favorable echocardiographic and clinical outcomes after CRT. [source]

    Electrocardiogram-Based Algorithm to Predict the Left Ventricular Lead Position in Recipients of Cardiac Resynchronization Systems

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2009
    SYLVAIN PLOUX M.D.
    Introduction: Biventricular pacing is associated with various electrocardiographic patterns depending on the position of the left ventricular (LV) lead. We aimed to develop an electrocardiogram-based algorithm to predict the position of the LV lead. Methods: The algorithm was developed in 100 consecutive recipients of cardiac resynchronization therapy (CRT) systems. QRS axis, morphology, and polarity were analyzed with a view to define the specific electrocardiographic characteristics associated with the various LV lead positions. The algorithm was prospectively validated in 50 consecutive CRT device recipients. Results: The first analysis of the algorithm was the QRS morphology in V1. A positive R wave in V1 suggested LV lateral or posterior wall stimulation. A QS pattern was specific of anterior LV leads. In the presence of an R wave in V1, V6 was analyzed to distinguish between an inferior and anterior LV lead. Inferior leads were never associated with a positive V6. To differentiate between lateral and posterior positions, we analyzed the pattern in V2. Lateral leads were associated with an R morphology in V1 and a negative V2. Posterior leads were associated with an R morphology in V1 and V2. The algorithm allowed a reliable distinction between an inferior or anterior and a lateral or posterior lead position in 90% of patients. Inferior, anterior, lateral, and posterior positions were reliably distinguished in 80% of patients. Conclusion: This algorithm predicted the position of the LV lead with a high sensitivity and predictive value. [source]

    Sheathless Implantation of Permanent Coronary Sinus-LV Pacing Leads

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2 2006
    PETER HOFFMEISTER
    Background: Implantation of CS-LV pacing leads is usually accomplished through specialized sheaths with additional use of contrast venography and other steps. Direct implantation at a target pacing site could provide a simplified procedure with appropriate leads. Methods: A progressive CS-LV lead implant protocol was used, with initial attempts made to place the lead directly using only fluoroscopy and lead stylet or wire manipulation. Coronary sinus (CS) sheaths were only used later if direct lead placement failed. Results: There were 105 attempted implants with 96% (101/105) success. Leads were implanted sheathlessly in 69% (70/101) cases. Pacing parameters and final lead position did not differ significantly between implants that did or did not require sheaths for implants. Three peri-procedural complications occurred in implants where sheaths were used. In 33% (33/101) of implants, the leads were placed without the use of sheaths or contrast venography in 20 minutes or less. Conclusions: Direct placement of the CS-LV pacing lead without sheaths can be accomplished successfully in a majority of implants and in ,20 minutes in a third, without inferior pacing parameters. This may provide for shorter or less technically difficult or expensive procedures with low risk. [source]

    Preliminary Results with the Simultaneous Use of Implantable Cardioverter Defibrillators and Permanent Biventricular Pacemakers: Implications for Device Interaction and Development

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2000
    S. WALKER
    We report our preliminary experience with the combined use of implantable cardioverter defibrillutors (ICD) and biventricular pacemakers in six patients with heart failure and malignant ventricular arrhythmia. Two patients underwent ICD implantation for malignant ventricular arrhythmia after previous biventricular pacemaker implantation. One patient underwent biventricular pacemaker insertion for NYHA Class III heart failure after previous ICD implantation. Two patients underwent single device implantation. In the sixth patient, a combined implantation failed due to an inability to obtain a satisfactory left ventricular pacemaker lead position. The potential for device interaction was explored during implantation. In two patients a potentially serious interaction was discovered. Subsequent alterations in device configuration and programming prevented these interactions with long-term use. No complication of combined device use has been demonstrated during a mean follow-up of 2 months (range 1-4 months). Satisfactory ICD and pacemaker function has also been demonstrated. We conclude that combined device implantation may be feasible with currently available pacing technology and that further prospective studies are required in this area. [source]

    Effect of Left Ventricular Lead Concordance to the Delayed Contraction Segment on Echocardiographic and Clinical Outcomes after Cardiac Resynchronization Therapy

    JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 5 2009
    JEFFREY W.H. FUNG M.D.
    Introduction: The optimal left ventricular (LV) pacing site for cardiac resynchronization therapy (CRT) is unclear. The current study aims to explore the clinical significance of LV lead concordance to delayed contraction segment in CRT. Methods and Results: Concordant LV lead position was defined as the lead tip located by fluoroscopy at or immediately adjacent to the LV segment with latest contraction determined by tissue Doppler imaging. Echocardiographic and clinical outcomes among 101 consecutive patients with or without concordant LV lead positions were compared. There was no significant difference in changes in LV volumes and clinical parameters between patients with concordant (n = 46) or nonconcordant (n = 55) LV lead positions at 3 and 6 months. In multivariate analysis, the baseline asynchrony index (,= 1.092, 95% CI: 1.050,1.114; P < 0.001), but not LV lead concordance, was the only independent predictor of LV reverse remodeling. By Cox regression analysis, ischemic etiology, and LV reverse remodeling, but not LV lead concordance, were independent predictors of mortality (,= 2.475, 95% CI: 1.183,5.178; P = 0.016, and ,= 0.272, 95% CI: 0.130,0.567; P < 0.001, respectively), cardiovascular hospitalization (,= 1.551, 95% CI: 1.032,2.333; P = 0.035, and ,= 0.460, 95% CI: 0.298,0.708; P < 0.001, respectively), and heart failure hospitalization (,= 0.486, 95% CI: 0.320,0.738; P = 0.001 for LV reverse remodeling). Conclusion: LV lead concordance to the delayed contraction segment may not be a major determining factor for favorable echocardiographic and clinical outcomes after CRT. [source]

    Electrocardiogram-Based Algorithm to Predict the Left Ventricular Lead Position in Recipients of Cardiac Resynchronization Systems

    PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 2009
    SYLVAIN PLOUX M.D.
    Introduction: Biventricular pacing is associated with various electrocardiographic patterns depending on the position of the left ventricular (LV) lead. We aimed to develop an electrocardiogram-based algorithm to predict the position of the LV lead. Methods: The algorithm was developed in 100 consecutive recipients of cardiac resynchronization therapy (CRT) systems. QRS axis, morphology, and polarity were analyzed with a view to define the specific electrocardiographic characteristics associated with the various LV lead positions. The algorithm was prospectively validated in 50 consecutive CRT device recipients. Results: The first analysis of the algorithm was the QRS morphology in V1. A positive R wave in V1 suggested LV lateral or posterior wall stimulation. A QS pattern was specific of anterior LV leads. In the presence of an R wave in V1, V6 was analyzed to distinguish between an inferior and anterior LV lead. Inferior leads were never associated with a positive V6. To differentiate between lateral and posterior positions, we analyzed the pattern in V2. Lateral leads were associated with an R morphology in V1 and a negative V2. Posterior leads were associated with an R morphology in V1 and V2. The algorithm allowed a reliable distinction between an inferior or anterior and a lateral or posterior lead position in 90% of patients. Inferior, anterior, lateral, and posterior positions were reliably distinguished in 80% of patients. Conclusion: This algorithm predicted the position of the LV lead with a high sensitivity and predictive value. [source]